| Chicago Canine Rescue Foundation |
| Dog Adoption Application |
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| * Required field. Please fill out application entirely. If the question does not apply and it is a required field, then put "N/A". We suggest using Internet Explorer to fill out this form. Thank you! |
| Applicant/Co-Applicant Information |
| *First Name: | *Last Name: | *Date of Birth: | |||
| First Name: | Last Name: | Date of Birth: | |||
| *Street address: | |||||
| *City/*State/*Zip: | |||||
| *Main Phone #: | 2nd Phone #: | 3rd Phone #: | |||
| *E-mail: | |||||
| How long have you lived at this address? | |||||
| Do you own? | Rent? | ||||
| *Landlord's/Condo board's name/email/phone: | |||||
| How were you referred to the Chicago Canine Rescue Foundation? | |||||
| Family/Household Information |
| *Number of adults in the household: | Relationships: | ||
| Have all the adults in the household agreed to this adoption? | YesNo | ||
| *Number of children in the household: | Ages of children: | ||
| Have the children had pets before? | YesNo | ||
| *Is anyone in the household allergic to pets? | YesNo | ||
| *Who? | |||
| *Why would you like to adopt an animal from us? (Check all that apply) | |||
| Companion for self | |||
| Gift | |||
| Companion for child | |||
| Watch dog | |||
| Companion for another pet | |||
| Companion for another household member | |||
| Employment Information |
| *Employer: | Position held: | ||
| Street address: | |||
| *City/*State/*Zip: | |||
| How long have you been with this employer? | Work Phone: | ||
| Personal Reference Information |
| Please provide a personal reference other than a family member |
| *Name: | *Phone Number: | ||
| Email: |
| Pet Information |
| Have you had pets in the past or do you currently have pets? Please tell us about them |
| *Have you had or currently have a pet(s)? | YesNo |
| Name | Breed | Age | Gender | Altered | Where are they? |
| MF | YN | ||||
| MF | YN | ||||
| MF | YN |
| *Have you ever given an animal away or relinquished an animal to a shelter? | YesNo | ||
| *If yes, what were the circumstances? | |||
| *Do you currently have a Veterinarian? | YesNo | ||
| If yes, below is required. | |||
| Veterinarian Information |
| Veterinarian's Name: | Veterinarian's Phone: | ||
| When was your current pet's last visit to a veterinarian and why? | |||
| New Pet Information |
| *How long have you been looking for a pet? | |||
| *What will you feed your new pet? | |||
| How often will you feed your new pet? | |||
| *How much time are you prepared to allow for your new pet to adjust to your home? | |||
| *Are you able to afford a bill of $200-$400 (or more) for emergency veterinary care? | YesNo | ||
| *How much do you expect to spend on maintenance for your pet in a year? | |||
| Are you committed to providing a responsible home for your pet's entire life (15+ years)? | YesNo | ||
| If you have to move, what do you plan to do with your pet(s)? | |||
| *Who in the household will be the dog's primary care giver? | |||
| *Where will the dog be kept during the day? | *During the night? | ||
| How many times per day do you plan to take your dog outside? | |||
| How do you plan to house train your dog? | |||
| Do you have a fenced in yard? | YesNo | ||
| If yes, what size and what type? | |||
| *How many hours per day will your dog be left alone? | |||
| What would you do if your dog develops a problem with: |
| *Digging: |
| *Barking: |
| *Chewing: |
| *Aggression: |
By hitting submit, I certify that the information I have given is true. I understand that the Chicago Canine Rescue Foundation reserves the right to deny my application for any reason. I further authorize the investigation of all statements in this application. |
| Submit |
| Thank you for your application, The Chicago Canine Rescue Foundation |