Adoption Application
Thanks 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 36 hours.

For required responses that are not applicable, simply enter "N/A".

Date *
MM
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DD
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YYYY
NAME of dog(s) you are interested in adopting? *
Your answer
Personal Information
Enter your personal information here.
First name *
Your answer
Last name *
Your answer
Phone *
Your answer
Street *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Email *
Your answer
Facebook username (or N/A) *
Your answer
Your age (minimum 18 to adopt) *
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
Household Information
Enter your household information here.
Do you own or rent your home? *
If you rent, please provide your landlord's name (or N/A). *
Your answer
If you rent, please provide your landlord's phone number (or N/A). *
Your answer
If you rent, please have available a copy of your lease or a letter from your landlord stating that pets are allowed.
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 (or N/A)? *
Your answer
If children visit your home, how often and what ages (or N/A)? *
Your answer
Adoption Information
Enter your adoption related information here.
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 day will your adopted dog be alone during the week? *
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 *
Required
What would you do if you felt the adoption was not working out? *
Your answer
How ready are you to adopt? *
Not Ready Yet
Ready Now
Current Companion Animals
Enter your companion animal related information here.
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
Please notify your veterinarian to release information to Canine Humane Network for verification of vaccine records, etc.
Did you breed any of your companion animals? *
References and Legal
Enter your reference and legal compliance information here.
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. *
I have read this application in its entirety and I confirm that all statements contained herein are made by me and are truthful. I hereby enter my full name as confirmation via electronic signature. *
Your answer
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