Name of Applicant(s):

Name and Ages of all people living in your household:

Address:

City:

State:

Zip Code:               

Township:

County: 

Home Phone: (including area code)          

Cell Phone: (including area code)           

Email address:

How long have you lived at the above address?

Previous Address:

City:

State:

Zip Code: 

Who are you employed by?

Work phone: (including area code)          

Emergency Contact:

Name: 

Phone Number: (including area code):       

Name of animal you're interested in adopting:

Where did you learn about our animals (check those which apply)?
petfinder.org             article in the paper          Petsmart
radio station             friends/relatives
Other:  

How much time do you have to spend with the animal you are interested in adopting?

Are you familiar with the breed you are interested in?  Yes         No

Do you live in a (check which applies):
Home              Apartment                Mobile Home
Other:  

Do you: Rent         Pay Lot Rent (Mobile Home)          
Own (proof of ownership may be required)

To whom do you pay rent or pay lot rent?
Name:
Phone number (including area code):          

Do you live in your parent's home any part of the year?   Yes          No
If yes, provide parent's name:
Parent's phone number (including area code):          

Is anyone in your household allergic to animals?   Yes       No
If yes, who is and what are they allergic to?

Why do you want to adopt a pet (check all that apply)?
For children          Gift              Companion              Guard dog
Companion for current pet              Hunting                   Mouser
Other (please explain):   

Who will be in charge of daily pet care?

Where will the pet be kept during the day?
Yard              Outdoor Kennel           Garage              Crate
Basement       Inside Home               Fenced Yard
Other (please explain):  

Do you have a fenced yard?     Yes            No
If you answered Yes, what type of fencing do you have and how high is the fence?

Where will your new pet be kept at night?

Where will he or she be kept while at work?

If adopting a dog, where will he or she get exercise?

Under what circumstances would you give up a pet? Please think about this question. Things happen in life that leave us unprepared. People move, children are born, and problems occur. What would you do?

Are you familiar with the laws concerning rabies vaccinations for dogs and cats?
Yes            No

Are you familiar with dog leash and licensing laws?  Yes         No

How long would you allow for an adopted dog or cat to adjust to you, your home and your current pets (if you have any)? The answer to this question is NOT "as long as it takes." Please put some thought into this.

What would you do if they haven't adjusted after that period of time?

If adopting a dog, how would you deal with the problems of inappropriate chewing, housetraining, etc.?

Will you go to obedience classes with your dog?   Yes           No
If not, why not:

If adopting a cat, how would you deal with the problem of not using the litter pan or scratching, etc.?

Have you ever adopted a shelter animal before?    Yes       No
If yes, which shelter (please include location, i.e. town and state)?

Have you ever owned a pet?     Yes        No
If yes, what kind of pet?

If yes, do you still have the pet(s)?    Yes       No
If no, please explain:

List all the current pets living in your home or outside your home:

Name:   Dog    Cat   Other:
Breed:    Sex:  M    NM   F   SF

Name:   Dog    Cat   Other:
Breed:    Sex:  M    NM   F   SF

Name:   Dog    Cat   Other:
Breed:    Sex:  M    NM   F   SF

Name:   Dog    Cat   Other:
Breed:    Sex:  M    NM   F   SF

Name:   Dog    Cat   Other:
Breed:    Sex:  M    NM   F   SF

Name:   Dog    Cat   Other:
Breed:    Sex:  M    NM   F   SF

Name:   Dog    Cat   Other:
Breed:    Sex:  M    NM   F   SF

Name:   Dog    Cat   Other:
Breed:    Sex:  M    NM   F   SF



 

Veterinarian's name, location and phone number:

**Note: If you do not currently own a pet, since you are applying to adopt one, you will need a vet. We need to know which vet you plan to use to process your application.

Cumberland Valley Animal Shelter will provide you with all information we have with regards to the temperament of our dogs and cats. Do you acknowledge that many times we may not know the complete history of a dog or cat and you may therefore experience new behaviors which were unknown to us?              Yes        No

The Cumberland Valley Animal Shelter does not refund adoption fees or "exchange" one pet for another. CVAS reserves the right to refuse adoption to anyone, with or without cause. In some cases it may mean that an application is approved, but not for that animal. No animal will be adopted to prospective owners who mislead or fail to provide accurate information for this adoption application. Home evaluations may be made prior to adoption and can be made on a random basis after adoption. If upon inspection we find that information contained in this application is false, Cumberland Valley Animal Shelter has the right to turn down your request for adoption or remove the animal from your premises without a refund.

I certify that the above statements are true and agree to the conditions of this application:
I confirm and agree.     

**Please note that by clicking the confirm and agree button and then pushing submit, you are providing the electronic equivalent of your signature.