CHN Adoption Application 2017
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!

NAME of dog(s) you are interested in adopting? *
Your answer
First AND Last Name *
Your answer
Email Address *
Your answer
Phone Information - Cell *
Your answer
Alternate Phone # *
Your answer
COMPLETE Mailing Address *
Your answer
Occupation *
Your answer
Do you rent or own your home? *
Landlord's Name and Phone # If not applicable write N/A *
Your answer
Name EVERY member of household WITH AGE *
Your answer
Does Everyone in Household Approve of Adopting *
Please describe your type of home and yard: Such as: apartment, condo, townhouse, single family home etc. Do you have a fenced area? What type of fencing and height? (Not always required of new owners) *
Your answer
Part of our adoption process involves a home visit. Are you agreeable to a home visit? *
How many hours a day will the dog be alone? *
Your answer
Current Pets: All information must be given. Please list the name, type, breed, age, sex, and how long they have been with you in the box below. If you have no current pets, write NONE *
Your answer
Previous Pets (All information must given) Please list the names, type, breed, sex, why they left your care, and how old they were when they left your care. If you have never owned a pet write NONE. *
Your answer
Have you ever given up a pet? Please explain *
Your answer
Do you have a veterinarian? *
Name of your Veterinarian (if applicable)
Your answer
Phone Number of your Veterinarian (if applicable)
Your answer
Are your current pets (cats and dogs) spayed/neutered and up-to-date on vaccinations? *
Please describe why you would like to adopt *
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
Where will the dog be kept while you are not at home? *
Your answer
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
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