I would like a:       Male           Female             Doesn't matter

Age Range:   

Color: 

Hair length:     Short         Medium     Long        Doesn't matter

Any additional information you'd like to provide to help us match the animal you're looking for:

Full Name (including Maiden if it applies):

Date of Birth

Address:

City:

State:

Zip Code:

Township:

County: 

Home Phone: (including area code)    

Cell Phone: (including area code)     

Email address:

Emergency Contact Name (not spouse)

Emergency Contact Phone

How long have you lived at the above address?

Previous Address:

City:

State:

Zip Code: 

Are you planning to move in the next six months?

Occupation?

Please select which describes your status: Rent Pay Lot Rent (Mobile Home) Own (proof of ownership may be required

If you rent and cannot show us a copy of your lease, please list your landlord's name, phone number and email address:
Name:
Phone number (including area code):    
Landlord's email address:

Please complete the following for EVERYONE living in your household (include Maiden names if applicable):

Name

Date of Birth Relationship to Applicant

Name

Date of Birth Relationship to Applicant

Name

Date of Birth Relationship to Applicant

Name

Date of Birth Relationship to Applicant

Name

Date of Birth Relationship to Applicant

Name

Date of Birth Relationship to Applicant

Name

Date of Birth Relationship to Applicant

For all ADULTS in the household, please list previous addresses going back 5 years:

Have you ever adopted from a shelter or rescue before? Yes No

If yes, what was the name of the organization?

When did you adopt from the organization?

What's the name of the animal are you interested in adopting from CVAS (if applicable)?

Where will the pet be kept during the day?  

Where will your new pet be kept at night?

Since you are interested in a cat, let's talk cats for a second. Not all shelter pets are the same. Some cats prefer to be your only pet, yet others like cats and/or dogs. Some cats are playful; others, laid back, preferring to spend time by themselves; and others are more like dogs and want to be around you all the time. Please take a moment to answer the following questions. With your answers, CVAS staff will be able to help match a shelter pet with you and your household.

First, please take just a minute to think about EACH of these issues:

1. Working with your pet to adjust to a new home.

2. Providing proper food and shelter.

3. Annual vaccinations and preventative health care.

4. Providing adequate exercise.

5. Your lifestyle, energy level, and space situation.

6. Potential training and behavior issues.

7. Time you spend away from home each day.

What are you looking for in a pet? (Please include reasons to adopt and personality traits you would like.) If you are interested in a declawed cat, we often have some here at the shelter and can introduce you to those.

What behavior(s) would be unacceptable to you and what would you do about it?

What concerns, if any, do you have regarding adopting a rescue animal?

What would cause you to return this animal? PLEASE be sincere and honest on this. If we know what would be a deal-breaker for you, we can match you with a cat we know won't behave that way.

How and where will your cat get exercise?

Describe your household activity level so we can best match you with a pet: (check those which apply)  Quiet Noisy
Highly active Average Active Relaxed and easy going Frequent visitors

There are many reasons a cat may stop using a litter pan.  It may be medical (urinary tract problem), social (not enough pans per cats or upset over a new pet), or just litter pan management issues (cleanliness of pan or type of litter).  If this situation arose, how would you determine the problem and find a solution?

Please know that we are here to help you make a successful adoption.  You can call or email us with questions or concerns even weeks after taking your pet home. 

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

Please complete the following information about pets in your household during the past 5 years who are no longer with you.

Pet's Name:

Why is the pet no longer with you (if deceased, briefly explain cause)?

Pet's Name:

Why is the pet no longer with you (if deceased, briefly explain cause)?

Pet's Name:

Why is the pet no longer with you (if deceased, briefly explain cause)?

Pet's Name:

Why is the pet no longer with you (if deceased, briefly explain cause)?

Pet's Name:

Why is the pet no longer with you (if deceased, briefly explain cause)?

Veterinarian's name, location and phone number:

Home evaluations may be made prior to a dog adoption.  If you already have a dog and are approved to adopt another, a “doggie meet” will be arranged.  No adoption will be made to persons who mislead or fail to provide accurate information for this adoption application.

We understand how introducing a new pet to your home can cause a period of adjustment.  Please contact our adoption counselor for advice and assistance if problems arise.   If you find you can no longer care for an animal you adopted from us, please call to schedule a time to bring the animal back.  CVAS does not refund adoption fees nor exchange one pet for another.  

I certify that the information on this application is true and correct and further authorize Cumberland Valley Animal Shelter to contact any and all references and vet office listed to verify the information provided. 

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.

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

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