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Invalid Submission Values
Chautauqua County Humane Society Online Adoption Application
**IF THE CAT YOU ARE LOOKING AT SAYS "ADOPT ME AT PETSMART" YOU DO NOT HAVE TO FILL OUT AN ONLINE APPLICATION. APPLICATIONS ARE HANDLED IN THE STORE. THANK YOU**
What type of pet are you looking to adopt?
Why do you wish adopt this pet?
Companion for self
Companion for child
Companion for other pet
Companion for other person
Are you interested in a specific animal. Please put name of animal
Are you over the age of 18?
Do you live alone?
Ages of Adults?
Ages of Children?
Who will be responsible for the pet's care?
I live in a
Does anyone in the home have allergies to animals?
What animals/breeds have you had in the past?
What animals/breeds do you currently have?
Are all animals in the household up to date on vaccines?
Can you show proof if necessary?
Will you be bringing any dogs from home to meet a pet?
How many hours a day will your pet be without human companionship?
Do you plan on leaving your pet?
Alone in the house
In a crate/cage
Confined to a room/area
Run of the house
Do you plan on leaving your pet outside?
If yes, please explain
How many hours a day will your pet be outside?
What is the level of activity for your family?
Are your activities
How much grooming do you expect to do with this pet?
Are you able to provide preventative care (yearly vaccinations) and emergency care (for illness or injury) for this pet (estimated at $250-$300 a year)?
How often will you be visiting a vet each year?
Who is your vet now?
What vet have you used in the past?
Do you expect to move for any reason in the next 3 years?
Who will care for your pet if you cannot?
What circumstances would cause you to return your pet?
Are you ready to provide this pet with a permanent home for the rest of it's life, which can be 10-20 years?
Has a pet died in your home in the last 3 months?
If yes, from what?
Have you adopted from CCHS before?
Under what name and address?
Do you still have the pet?
If no, what happened?
**All medical costs incurred after adoption are the responsibility of the adopting party and not that of CCHS**
I certify the information I have provided is true to the best of my knowledge
Drivers License Number
Date of birth
Township (if applicable)
Select an option
Emergency Contact for Microchip (other than yourself)
Where did you see this pet listed
CCHS RESERVES THE RIGHT TO DENY ANY ADOPTION
PLEASE CLICK THE SUBMIT BUTTON ONLY ONCE AND THEN WAIT FOR THE FORM TO PROCESS. THANK YOU.