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  • Adoption Application

  •  / /
  • Format: (000) 000-0000.
  • Are you over 21 years old?
  • Are you currently employed?
  • If unemployed, how will you financially support your new pet? Select all that apply:
  • Are you a student?
  • Format: (000) 000-0000.
  • Do you have a Co-Applicant (a secondary adult such as a spouse, partner, or roommate who will be a primary caretaker for the animal)?
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  • Is the Co-Applicant's address the same as above?
  • Format: (000) 000-0000.
  • Is the Co-Applicant over 21 years old?
  • Is the Co-Applicant employed?
  • Is the Co-Applicant a student?
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  • Do you own or rent?
  • Type of Residence:
  • If you rent, do you have any of the following restrictions? Select all that apply:
  • Do you live with parents?
  • Has anyone living in the home ever been convicted of a felony?
  • I understand that a background check may be conducted:
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  • Why would you like to adopt a pet? Check all that apply:
  • Have you ever had to get rid of a pet?
  • Under what circumstances would you not keep an animal? Check all that apply.
  • Do you currently have a veterinarian?*
  • Format: (000) 000-0000.
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  • I am interested in adopting a:

  • If Interested In Adopting A Dog:

  • How will you keep the dog confined to your property? Check all that apply.
  • I understand that CHA has outdoor play yards where dog-to-dog introductions can occur and that it is greatly encouraged for resident dogs to be brought to the shelter at the time of my visit to make sure everyone gets along before adoption.

  • If Interested In Adopting A Cat:

  • Will the cat be allowed outside?
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  • Pet History

    Please provide information on ALL of the pets you currently own and the pets you have had within the last 10 years.
  • I have owned animals within the last 10 years.

  • Name:
    Breed:
    Age:   year(s)
    Spayed/Neutered:                                 
    Where is the pet housed?:                 
    Do you still have the pet?          
    If no, where is pet now?                         

  • Name:
    Breed:
    Age:  year(s)
    Spayed/Neutered:            
    Where is the pet housed?:                   
    Do you still have the pet?:           
    If no, where is pet now?                                       

  • Name:
    Breed:
    Age:   year(s)
    Spayed/Neutered:            
    Where is the pet housed?:                    
    Do you still have the pet?:           
    If no, where is pet now?                                     

  • Name:
    Breed:
    Age:   year(s)
    Spayed/Neutered:            
    Where is the pet housed?:                  
    Do you still have the pet?:           
    If no, where is pet now?                           

  • Name:
    Breed:
    Age:   year(s)
    Spayed/Neutered:            
    Where is the pet housed?:              
    Do you still have the pet?:               
    If no, where is pet now?                                     

  • Name:
    Breed:
    Age:   year(s)
    Spayed/Neutered:            
    Where is the pet housed?:              
    Do you still have the pet?:             
    If no, where is pet now?                                       

  • If any animals are/were not spayed or neutered, what was the reason?:
  •  - -

  • OPTIONAL:

  • NOTE: CHA Animal Shelter is unable to accommodate any type of “hold” for any animal. Interested adopters can fill out and submit an application to remain on file for convenience but filling out an adoption application does not guarantee that a person will be first for a specific animal in any situation.

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