Adoption Form

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Adoption Form

Please note that due to the health vulnerabilities of some of our senior dogs, we cannot consider smoking homes in any form.

Email *

How did you hear about Citizen Canine Senior Dog Rescue?

Facebook

Citizen Canine Senior Dog Rescue Website

Nextdoor

Word of mouth

Other:

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In which one of our currently available senior dogs are you interested? OR If you are not interested in one of our current dogs but would like us to contact you when we get a dog like the one you want, state what kind of dog you are looking for.

Would you be interested in adopting a bonded pair of dogs? (These are dogs that have been together for a long time, and for whom it would be best to not separate)

Yes

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First Name *

Last Name *

First Name of Spouse/Partner/Roommate

Last Name of Spouse/Partner/Roommate

Address (include apartment # if relevant) *

City *

State *

Zip Code

County

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This form was created inside of Citizen Canine Senior Dog Rescue.