CCHS Dog Application
In order to adopt an animal from the CCHS, these policies must be followed.
Please read and understand the following policies before filling out this application:
1. In order for us to process your application, this application must be filled out completely.
2. For approval of your application, the adoption must be in the best interest of both the person(s)
adopting, and the animal.
3. Your completed application could take 1-2 days to process.
4. False or omitted information will deny your application.
5. If you are applying for an animal that has not yet been spayed/neutered, the animal must be
spayed/neutered before leaving the facility.
6. You must be at least 18 years of age to adopt an animal. (Present valid ID if asked to do so)
7. All currently owned dogs must be current on rabies vaccinations. This is Michigan State Law.
8. The Copper Country Humane Society may deny your application if, in our judgment, it is not
the best home for the animal.
9. If we leave a message concerning your application and we do not hear back from you within 48
hours, your application may be cancelled.
10. Indicate by your signature on the last page that you agree to all the requirements and
conditions stated in the adoption agreement.
Is there a dog you are interested in? (If you are not sure you can leave this blank)
Your answer
General Information
Primary Applicant's Name *
Your answer
Street and Mailing Address (Include city, state, zip) *
Your answer
Email Address
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Driver's License/State ID Number *
Your answer
How would you like us to contact you? *
Co-Applicant Name (if applicable)
Your answer
Are you a student? *
Do you have a different address for the school year?
If yes, please give address at school.
Your answer
Have you ever adopted from ANY shelter? *
If yes, which shelter?
Your answer
Property Information
How long have you lived at this residence? *
Your answer
Do you plan to move soon? *
Type of dwelling *
If you live in an apartment, is there a yard you can use?
Do you: *
If you rent does your lease allow you to have pets?
Landlord name (required if you rent)
Your answer
Landlord phone number (required if you rent)
Your answer
Are you currently employed *
Living Arrangement Information
Please list the names of anyone over the age of 18 living with you *
Your answer
How many children are in the home? *
Your answer
What are their ages?
Your answer
If there are children in the home are they accustomed to being with animals?
If you have children, do you expect them to be the primary caretaker of the animal?
Are all persons in your household aware that you are applying for a pet? *
Does anyone in your home have asthma or allergies? *
If anyone in your home has asthma or allergies, how severe are they?
Your answer
Compatibility Information
Why do you want to adopt this animal? *
Your answer
Exercise/activity in my house is usually: *
I'm looking for a pet to be (select all that apply) *
Required
How much time will your animal spend alone each day? *
Your answer
Where will the pet be kept during the day? (If other please explain) *
Where will the pet be kept when you are not at home? (If other please explain) *
Where will the pet sleep? *
Your answer
What will you do with the pet if you move? *
Your answer
Have you ever given an animal away or surrendered to a shelter? If yes, why? *
Your answer
Have you ever had a pet euthanized? If yes why? *
Your answer
Do you have a fenced in yard? *
Are you familiar with local ordinances/laws regarding pet ownership where you live? *
A pet is a long-term commitment. They can live for 15 or more years. It will likely take time for the dog to bond with you; it may not take place in the first few hours, few days or even possibly a few weeks. Are you willing to take the time to work with the dog you plan to adopt? *
Is there anything else you would like to tell us?
Your answer
Pet History
Please list all pets you currently own or have owned in the past 5 years. Please include owner (you, parents, roommates), animal name, type of animal (cat, dog, etc), male/female, spayed, neutered, or not, age, # years owned, indoor/outdoor, alive/deceased. *
Your answer
If a pet is not spayed/neutered, please explain why
Your answer
Current veterinarian and vet's phone number
Your answer
Name on account with veterinarian
Your answer
Do you have past records with any other veterinarians? If yes please list.
Your answer
Personal references
Please give names of a relative, friend and neighbor (or another friend)
Personal reference #1 (Name, phone #, relation) *
Your answer
Personal reference #2 (Name, phone #, relation) *
Your answer
Personal reference #3 (Name, phone #, relation) *
Your answer
Adoption Contract
You will sign this agreement when you come to adopt a pet.
STATEMENT OF UNDERSTANDING AND AGREEMENT
~PLEASE READ CAREFULLY!~
THIS IS A LEGAL AND BINDING CONTRACT
1. I agree to provide proper food, water, shelter, kind and humane treatment to this and all pets at all times. A pet will not live its life on a chain or outdoors.
2. I agree to take this animal to a veterinarian for examinations/immunizations as needed and to procure immediate care should the animal become ill or injured.
3. I will not allow this animal to be used for medical/experimental purposes. No unnecessary or inhumane surgery will be performed.
4. If I cannot keep this animal, I AGREE TO SURRENDER BACK TO CCHS. I AGREE THAT I WILL NOT GIVE THIS ANIMAL TO ANOTHER HOME OR SELL THIS ANIMAL. If I know someone who wants the animal, I will let CCHS know and have that person go to CCHS and fill out an adoption application. I agree that the animal WILL NOT go into a new home until their application is approved.
5. I agree to license this dog in compliance with the laws/ordinances for the municipality in which I reside.
6. I agree not to transport this dog in the back of an open bed truck at any time.
7. I understand that the Copper Country Humane Society cannot guarantee the health, temperament or training of any animal being adopted and hereby release the CCHS from ALL liability once the animal is in my possession. Further, I understand that shelter animals have been potentially exposed to certain diseases, including but not limited to Bordatella (kennel cough), distemper, parvovirus, rabies and intestinal parasites.
REMEDY FOR NON-COMPLIANCE: It is agreed that the Copper Country Humane Society retains superior title in said animal, limited to and for the express purpose of assuring the animal’s well-being. CCHS will only exercise its superior claim in the event that it appears to the CCHS or animal control that the proper and humane care as specified in the adoption agreement is not being afforded the said animal, the animal is being sold/rehomed without express permission of CCHS OR in the event that any information in the adoption application has been falsified, in which case the animal CAN be taken back by CCHS.
I have read the above agreement and completely understand and accept the rights, responsibilities and obligations involved. I also agree to abide by the answers given in the adoption application. I certify that all statements made on this adoption application are made truthfully and without evasion and if any statements are found false, my application may be denied.
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