Coopers Chance Adoption Application

Cooper's Chance Animal Rescue

Dog Adoption Application
We are a 501c3 nonprofit, no kill animal rescue established in 2006. Our mission is to rescue, rehabilitate and re-home abused and neglected animals. Our rescued pets are placed into loving foster homes and receive one on one attention, complete vet care, training and socialization.

Adoption Process inclues Application (Must be 18 years old), Meet and Greet (at your home or foster home), 24 hr Trial Run (Optional), Adoption Agreement, Records Release.

All rescued pets are spayed/neutered, vaccinated, microchipped and dewormed and include adoption welcome kit with leash, collar, food, treats and toys.
Please fill out the questionnaire completely. A representative from our Adoption Team will contact you as soon as possible to discuss the pet you are interested in adopting. If a question does not apply to you, please write N/A in the response area. Thank you!
Date*

MonthDayYear
Date
Name of the dog you are interested in:*
Referred By

Applicant Information
Applicant's full name:*
Co-Applicant's full name (if living in same household as Applicant):*
If there is only one applicant please type N/A
Street Address:*
City, State, Zip*
Major Cross Streets
Applicant's Phone:*

Area CodePhone Number
Co-Applicant's Phone:

Area CodePhone Number
Applicant's E-mail:*
Co-Applicants E-mail:
Applicant's Employer:*
Co-Applicant's Employer:

I/we am/are at least 18 years of age. All of the information I/we have given is true and complete. I/we understand that CCAR has the right to refuse my/our application. I/we understand that CCAR has the right to reclaim any foster or adopted dog/cat if doing so is in the dog/cat’s best interest. I/we agree that CCAR and its representatives bear no responsibility for any and all damage costs or expenses, liquidated or otherwise incurred, resulting from fostering or adopting, including but not limited to, damage or injury to persons or property by the dog while in foster care or adopted, and in this connection, I/we release, indemnify and hold CCAR harmless from any and all liability of any and every nature and cause directly or indirectly relating to this placement.
Applicant Signature*

Clear
Date*

MonthDayYear
Date
Co Applicant Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Cooper's Chance Animal Rescue