Online Adoption Application - Chautauqua County Humane Society

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? (required)

Are you interested in a specific animal. Please put name of animal

Are you over the age of 18? (required)

Yes

No

Do you live alone? (required)

Yes

No

Ages of Adults? (required)

Ages of Children?

Who will be responsible for the pet's care? (required)

I live in a (required)

House

Apartment

Mobile Home

With Parents/other

I own/rent (required)

Own

Rent

Landlord Name

Landlord Phone

Please attach a copy of your current lease agreement that shows you are able to have pets

Does anyone in the home have allergies to animals? (required)

Yes

No

What animals/breeds have you had in the past? (required)

What animals/breeds do you currently have? (required)

Are all animals in the household up to date on vaccines? (required)

Yes

No

Can you show proof if necessary? (required)

Yes

No

Will you be bringing any dogs from home to meet a pet? (required)

Yes

No

How many hours a day will your pet be without human companionship? (required)

Do you plan on leaving your pet? (required)

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? (required)

Yes

No

If yes, please explain

How many hours a day will your pet be outside? (required)

What is the level of activity for your family? (required)

Quiet

Average

Active

Hectic

Are your activities (required)

Mainly indoor?

Mainly outdoor?

How much grooming do you expect to do with this pet? (required)

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)? (required)

Yes

No

How often will you be visiting a vet each year? (required)

Who is your vet now? (required)

What vet have you used in the past? (required)

Do you expect to move for any reason in the next 3 years? (required)

Yes

No

Who will care for your pet if you cannot? (required)

What circumstances would cause you to return your pet? (required)

Are you ready to provide this pet with a permanent home for the rest of it's life, which can be 10-20 years? (required)

Yes

No

Has a pet died in your home in the last 3 months? (required)

Yes

No

If yes, from what?

Have you adopted from CCHS before? (required)

Yes

No

Under what name and address?

Do you still have the pet?

Yes

No

If no, what happened?

**All medical costs incurred after adoption are the responsibility of the adopting party and not that of CCHS** (required)

Agree

I certify the information I have provided is true to the best of my knowledge (required)

Agree

Name (required)

Today's Date (required)

Example: ##/##/####

Drivers License Number (required)

Date of birth (required)

Home Phone

Cell Phone (required)

Address (required)

Address (2)

Township (if applicable)

City (required)

State(required)

Zip (required)

Email (required)

Example: janedoe@fakeemail.com

Are you a veteran of or are you currently serving in the military with a valid Military I.D.?

Yes

No

Emergency Contact for Microchip (other than yourself) (required)

Where did you see this pet listed (required)

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.