Chances Animal Rescue

Please complete all fields. If a question does not apply, enter None or Not Applicable in the field. Thank You.

What pet are you applying for?	1st Choice: 2nd Choice:
Personal Information
Full Name (first, last, middle inital)
Date of Birth
Address
City, State, Zip
Daytime Phone
Evening Phone
Email Address
Occupation
Employer

Family
Spouse/Partner/Roommate's Name
Date of Birth
Ages of Children in household
I would describe my household as:	If other, Explain:
Does anyone in the family have a known allergy to dogs?
Is everyone in the family in agreement with the decision of adopting a dog?
Are you able to provide this dog with enough love and attention?

Housing
Do you own or rent your home?
If you rent, please provide your landlord's name and phone number:	Name: Phone:
Type of Home you live in:	If other, explain:
Where will dog be kept?	Please explain if both indoors and outdoors:

Other Animals
Please give the names and information for the current animals in your household, and any you have had in the last five years

Pet #1
Type of Animal (dog, cat, bird, etc.)
Name
Breed
Age
Sex
Spayed/Neutered
Inside or Outside?
Does this pet still live with you?
If no, why not?

Pet #2
Type of Animal (dog, cat, bird, etc.)
Name
Breed
Age
Sex
Spayed/Neutered
Inside or Outside?
Does this pet still live with you?
If no, why not?

Pet #3
Type of Animal (dog, cat, bird, etc.)
Name
Breed
Age
Sex
Spayed/Neutered
Inside or Outside?
Does this pet still live with you?
If no, why not?

Pet #4
Type of Animal (dog, cat, bird, etc.)
Name
Breed
Age
Sex
Spayed/Neutered
Inside or Outside?
Does this pet still live with you?
If no, why not?

Use the comment section at the bottom if you have more.

If you currently have a dog(s), we require a "Meet & Greet" here at the shelter with all dogs in your home.
Your dog(s) MUST be up-to-date on vaccinations before this can take place.

Veterinarian
Please give the name of your current veterinarian, or any veterinarians you have used in the past five years. Please contact your Vet clinic to release your vaccination records to us. All Cats & Dogs in your home MUST be up-to-date on Rabies & Distemper vaccines before we can adopt to you. If they are not, please schedule an appointment to have them updated and inform us of the date.
Veterinarian/Clinic Name
Address
City, State, Zip
Phone Number

What are you looking for in a dog?
I am looking for a dog who is: Check all that applies:	Active Laid Back Good with Kids Good with dogs
I would be comfortable adopting: Check all that applies:	Outgoing/Energetic Dog that needs medication Dog that needs grooming Dog that needs training None of these
Where will the dog spend the day?
Where will the dog spend the night?
Average number of hours dog will be alone?
Who will be responsible for the dog's care?

References:
Please provide two personal (non-related) references
Reference #1 Name
Reference #1 Phone
Reference #2 Name
Reference #2 Phone

Would you like to be added to our Email Mailing List?

Other Information
Do you have any other information or comments that would be helpful in consideration of this application?

By submitting this application, I certify that the information I have given is true and correct. I agree that this dog will reside in my home as a companion, and will be given proper care including food, water, veterinary care, exercise, and affection. If this application is approved and Chances Animal Rescue should later discover that the above information is not true, Chances Animal Rescue may remove the adopted pet from my home, holding me responsible for any legal costs associated with the reclamation of this animal. I understand that Chances Animal Rescue reserves the right to deny any adoption application

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