CHN Adoption Application

Thank you for your interest in adopting a dog! The application helps us make sure we're making a good match.
Canine Humane Network makes every effort to communicate to new families the breed and age of their dog as well as any behavior or medical problems that they are aware of, they do not make any representation or guarantee about the behavior, health, breed or age of any rescue dog.

After completing the application, we will contact you with the information you have provided to us within 48 hours.

For required responses that are not applicable, simply enter "N/A".
Today's Date *
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What is the name of the dog you are interested in adopting? (Please note, CHN only accepts applications for pups available on Petfinder) *
Your answer
First Name *
Your answer
Middle Name *
Your answer
Last Name *
Your answer
Co-Applicant's Name if applicable (first, middle last Name)
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
County *
Your answer
Primary Phone *
Your answer
Email Address *
Your answer
Facebook User Name if applicable
Your answer
Birthdate/age *
Your answer
Do you have your own reliable transportation? *
Occupation / employer? *
Your answer
What insurance do you have? *
Required
Have you ever been convicted of a felony, criminal charges, or been placed on probation? *
If yes, please explain (or N/A) *
Your answer
Do you own or rent your home? *
If you rent, please provide your landlord's name and phone number.
Your answer
What type of home do you live in? *
Do you have a fenced yard? *
If so, what is the fence height and material? (or N/A) *
Your answer
How many adults live in your home? *
Your answer
How many children live with you and what are their ages? *
Your answer
If children visit your home, how often and what ages (or N/A)? *
Your answer
Are all members of your household aware of and supportive of your interest in adopting a dog? *
How did you hear about Canine Humane Network? *
Your answer
Why would you like to adopt a dog? *
Your answer
Where will your adopted dog sleep at night? *
Your answer
Where will your adopted dog be kept when you're not at home? *
Your answer
About how many hours per weekday will your adopted dog be alone? *
Your answer
About how many hours per day will your adopted dog be alone during the weekend? *
Your answer
Would you be opposed to taking your dog to a trainer if the dog needed it? *
Please check any training equipment your plan to use *
What would you do if you felt the adoption was not working out? * *
Your answer
How Ready are you to Adopt? *
Not Ready
Ready Now
Do you currently have any pets of your own? *
If so, please provide names, types, breeds, genders, ages, if indoors or outdoors, and how long you have owned them (or N/A). *
Your answer
Are your current cats and dogs spayed/neutered and up-to-date on vaccinations? *
If you have had any previous pets, please provide names, types, breeds, genders, ages, if spayed or neutered, if indoors or outdoors, why they left your care, how old they were when they left your care, and how long you had owned them (or N/A). *
Your answer
Have you ever given up a pet? If so, please explain (or N/A). *
Your answer
Do you have a veterinarian? *
Name of your Veterinarian (or N/A)? *
Your answer
Phone Number of your Veterinarian (or N/A)? *
Your answer
Did you breed any of your companion animals? *
Please provide a primary reference, name, phone number and relationship. *
Your answer
Please provide a secondary reference, name, phone number and relationship. *
Your answer
I agree that all statements in this application are made based on personal knowledge and are made for the purpose of my application to adopt one or more dogs through Canine Humane Network. *
I understand that a Canine Humane Network representative may visit my home for a home inspection prior to the approval of my adoption application and I so consent. *
Your answer
If under the age of 21 -parent co-sign I understand that a Canine Humane Network representative may visit my home for a home inspection prior to the approval of my adoption application and I so consent. *
Your answer
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