Adoption Form
Applicant Information: All fields with a (Asterisk *) are required fields.
Chi Name, ID#
First Name*
Last Name*
Your Age
E-Mail *
Occupation
Address1
Address2
City
State
Zip/Postal Code
Country
Home Phone*
Cell Phone
Work Phone
Spouse/Sig Other/Children/Roommates
Spouse's Name
Spouse's Age
Children
Yes
No
If Children, Ages
Roommate (s)
Yes
No
If Roomates, Ages
Residence Information: A letter from your landlord or apartment manager will be required if you rent.
Own/Rent
Own
Rent
Time At Current Address
Type Of Residence
House
Apartment
Condo/Townhouse
Mobile Home
Does Your Landlord allow pets
Yes
No
I Dont Know
Landlord's Name
Landlord's Phone
Type Of Fence
Highest Point
Lowest Point
Type Of Gate
Number Of Gates
Height Of Gate (s)
Type Of Lock
Padlock Key
Entry Latch
Do You Have A Pool
Yes
No
Is Your Pool Fenced In
Yes
No
Expecting To Move In The Next Few Months
Yes
No
This Dog Will Be
Indoor Only
Mostly Outside
Mostly Indoor
Outdoor Only
When Will The Dog Be Inside (Be Specific)
When Will The Dog Be Outside (Be Specific)
Is Anyone In Your House Hold Allergic To Dogs
Yes
No
Is Someone Home During The Day
Yes
No
Hours Alone
Which Rooms, If Any, Are Off Limits To The Dog(s)
Is The Dog Allowed On The Furniture
Yes
No
Where Will The Dog Sleep At Night (Be Specific)
When You Go To Work, Where Will The Dog Be
Yard
Goes to work with me
Doggie Day Care
Garage
Other
If Other, Explain
Do You Have A Gardener
Yes
No
Do You Have A Doggie Door
Yes
No
Training & Disclipine
What Method Will You Use To Housetrain Your Dog
Do You Have Experience With Dog Training
Yes
No
If Yes, What Experience And What Training
In Which Of The Following Situations, Will You Have Your Dog Off Leash
Park
Dog Park
Small Dog Park
Hike
Neighborhood Walk
Front Yard
Back Yard
Beach
Will not be off leash
Discipline's Used If Your Dog Misbehaves
What Would You Do If The Behavior Continued
Which Of The Following Disclipines Will You Use If Your Dog Just Won't Listen And Is Really Naughty
Spank with hand
Spank fanny with newspaper
Swat nose
Stern voice
Give the dog a time out
Important Information
Under What Circumstances, Will You Not Keep Your Dog
Divorce/Separation
Allergies
Dog barks a lot
Sheds too much
Housebreaking problem
Kids ignored the dog
Pets didn’t get along
Dog nips at strangers
Dog bites kids
Dog loses control of bladder
Scratches/Chews furniture
Bit or snapped at another animal
Dog develops chronic illness
High vet bills
Dog is just untrainable
Dog is NOT the kind of dog I thought
Having a baby
Move to apartment that doesn’t allow dogs
Move out of the state
Move out of country
Will always keep This Dog
Will You Be Able To Live With Fur On Your Furniture, Stains On Your Rugs, And A Dog Who May Be Destructive At Times
Yes
Yes
Can You Afford Regular Veterinary Care For This Dog - Including Yearly Vaccinations, Annual Physical Exams, Dental Care, Etc
Yes
No
Can You Afford Serious Injury Or Illness Costs? ($1,000.00 Or More)
Yes
No
Vet Information : Please Give Us Your Vets Contact Information Please Note We Will Be Calling Your Vet To Check References.
Vet Name
Vet Address
Vet City
Vet Phone Number
Pet History Please Fill Out For All Animals, Past & Present. Do Not List Fish Or Reptiles. Place one pet on each line!!
Species Breed / Weight / Sex / Ages Owned / Sterilized / Still Have
In Regards To The Above Animals, What Happened To The Pet(s) You No Longer Have? Please Explain
Hit By Car
Old Age
Died Of Disease
Gave Away
Gave To Shelter
Gave Back To Rescue Group
Put To Sleep
Other
The Pet That You Have Now Is It Spayed Or Neutered
Yes
No
Would You Agree To An Inspection Of Your Premises
Yes
No
What Are Our Primary Reason For Wanting To Adopt A Dog
Companion For Me
Companion for another pet
Child Wants A Dog
Protection
Gift
Some Final Stuff For You To Know Please Note We regret that we are unable to respond to any applications unless all questions are answered and veterinarian information has been provided. Thank you for your interest in adopting a dog from CHI ANGELES RESCUE. Please be advised that filling out this application is not a guarantee of adoption. Any false information may result in nullifying the adoption. We reserve the right to refuse to adopt to any applicant for any reason. By signing below you attest that all information above is true and correct to the best of your knowledge!!
Signature*
Date*
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