Champlain Valley Canine Rescue - Adoption Application

Contact Information

Full Name:

Street Address:

City:

State:

Zip Code:

E-mail Address:

Primary Phone Number:

Secondary Phone Number:

(optional)

Preferred Time for a Telephone Interview:

Residence and Environment Information

How many people reside in the home?

What are their ages?

How many pets reside in the home?

What are their breeds, ages and genders?

What type of residence do you reside in?

What is the maximum number of animals permitted in your township?

Home and property sizes:

Do you rent, or own?

Own Rent

Do you have a fully fenced yard?

Yes No

What are the dynamics of the home?
(work schedule; how long will animal be left alone)

What type of dog/cat are you looking for? (age, sex, breed)

Describe how active your family is on a daily basis and how the canine would be incorporated into it:

Applicant Information

Have you applied elsewhere in the last three months for a canine?

Yes No

What is your training experience?

Would you attend dog training classes?

Yes No

Where would the animal stay when you are away?

Which one of our dogs are you applying for?

(See Available Dogs)

Why would this be an ideal match?

References

Veterinary Reference

Vet Name:

Vet Phone Number:

Pet name your account is listed under:

Have you informed your vet that CVCR will be contacting them?

Yes No

1st Personal Reference

(cannot be relatives of the applicant)

Reference Name:

Phone Number:

Best Time to Call:

2nd Personal Reference

(cannot be relatives of the applicant)

Reference Name:

Phone Number:

Best Time to Call:

3rd Personal Reference

(cannot be relatives of the applicant)

Reference Name:

Phone Number:

Best Time to Call:

Additional Information

Please provide any additional info that may be helpful in working with us to find you a canine or feline for your family.

(optional)

How did you hear about us?

Type the letters and numbers you see into the box below: