Chanute Animal Shelter Adoption Application
Pet Adoption Application
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To reach us call (620)431-5768 or e-mail
Type of pet requested or Pet's Name (DO NOT PUT YOUR NAME) *
First AND Last Name *
Phone *
Date of Birth *
Address *
City *
E-Mail Address *
Please check all applicable reasons for wanting to adopt this pet *
Do you own or rent? *
How long at current address? *
Does your lease permit pets? *
May we contact your landlord? *
If renting, include Landlord name and phone number *REQUIRED* *
Will your new pet live primarily inside or outside? *
Do you have a fenced yard? If not, how will you confine your new pet when outside? *
Any children in the home? *
If yes, what are their ages?
Will the pet be alone for more than 6 hours at a time?
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Do you plan on having this pet spayed/neutered? *
Are you willing/able to provide any medical and other care needed during the pet's life, including preventative vaccinations, grooming, etc? *
Please list what pets own now or within the past 5 years. Please mention their name, breed, sex and whether they've been spayed/neutered, current on shots, licensed and whether they're a house pet or outdoor.
Have you ever surrendered an animal you owned to a shelter or humane society? IF YES, please explain *
Have you ever lost an animal to parvo, distemper, or other preventable diseases? IF YES. Please explain. *
May we contact your vet? *
Include name and phone number if yes.
Have you ever been convicted of animal cruelty or neglect? Any other animal related crimes? Please explain. *
Where did you hear about this pet?
Any additional information that you would like us to consider:
I certify that the above information is true and accurate to the best of my knowledge, and that falsification of information can be cause for denial of my application. By typing my name below, I understand and agree that this form of electronic signature has the same legal force and affect as a manual signature. *
IMPORTANT! If you do not receive a reply within 24 hours, please call or email to verify that it has been received  (620)431-5768 or
(620)431-5768 or
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