Date *

Name(s) of Perspective Pet Parent *

Name and Breed of Pet You Wish to Adopt *

Where Did You Hear About This pet?

Email Address *

Mobile Phone Number *

Other Phone Number

Street Address *

City, State, Zip *

Do You Own Any Pets? *

Current Pet Name(s)/Species/Breed(s)

Current pet's disposition and behavior towards other dogs/cats?

Please provide your veterinarian's name and phone number:

Do you own or rent your home? *

If you rent, what is your landlord's pet policy?

Do you have a yard? *

If "Yes" to the above, is it fenced? please describe type and height.

Have you ever moved from one residence to another and could not/did not take your pet? If yes,please explain. *

Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill"shelter? *

Are there children in the home? (If yes, please list ages) *

How many hours per day would the pet be alone? *

Will you crate your pet? *

If you have to leave town, urgently or planned, where would your pet stay? *

When outdoors, what shade and shelter are available for the pet? *

Where will your pet be kept during the day? *

Where will your pet be kept during the night? *

How would you deal with behavioral issues such as barking, chewing, destructive behavior,bathroom accidents indoors, unruly leash behaviors in your pet? *

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft,or animal abandonment? *

If you answered "Yes" please provide a detailed description:

Would you object to a home visit by one of CPP's representatives? *

All CPP dogs are current on basic vaccinations as well as on monthly heartworm and flea-tick preventatives. If adoption is approved do you agree to maintain annual vaccinations and monthlyheartworm preventative as prescribed by a licensed veterinarian. *

Please check all boxes *

Digital Signature of Potential Pet Parent *