ADOPTION APPLICATION:

Name of pet you are interested in *

Reasons for adoption *

What drew you to him or her? Who will be responsible for the majority of the care for this pet? Having a pet is a serious commitment. Do you have time, resources and energy to commit to a new pet? Is everyone in your household onboard with the adoption? If you have young children, what safety measures are you willing to take to ensure your children and your pet will be safe together?

For whom are you adopting this pet?

Yourself? Family Member? Friend?

Name *

Name

First Name

Last Name

Best telephone number to reach you on? *

Best telephone number to reach you on?

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Email Address *

Home Address *

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Names. ages, and breeds of current pets *

Please list names, ages and breeds of all current pets.

Former Pet History *

Please list the types and breeds of pets you have owned in the last ten years - Include type of animal, age, how long, and what happened to him/her?

Personal references

If you have never had a pet, please provide us with the names and telephone numbers of three personal references. What is their relationship to you?

Have you ever had a cat declawed?

About Your Household

How many adults in your household? How many children in your household? Ages of each child?

Do you work outside the home? *

Number of hours you work per day away from home *

Where will your pet spend his or her time when you are out? *

Vet's Contact Information

Vet's telephone number including area code? The name the account is under? The names of the pets seen by this vet? Please let your vet know that a volunteer from CHS will be calling and they have your permission to speak with us.

Amount you are willing to spend on your pet per year? *

Pet Survey

What characteristics are you looking for in a pet? My pet needs to be good with: Children? Elderly People? Cats? Other dogs? Animals other than dogs and cats? Please list.

How do you plan on training your new pet?

Do you have a fenced in yard? *

Please describe the land where your pet will be able to play in around your home?

How do you plan on providing your dog with daily exercise?

Please choose the type of energy level you are looking for in a pet

Pet Behavior *

What “normal” dog behavior challenges are you prepared to deal with? (e.g., chewing, housebreaking, barking etc.). What reason would you return a pet? What behaviors concern you the most? Would these cause you to return the dog to us?

Are you actively involved in breeding your pet?

If yes, how many litters per year?

Have you ever returned a pet? *

If yes, please describe the circumstances.

Have you ever been convicted of animal abuse? *

Adoption Form Agreement *

By submitting this application, I certify that the above information is true. I also understand that giving false information on this application is grounds for denying my application. This application remains the property of the Culpeper Humane Society. Our adoption fee varies per dog from $150 - $250, depending upon age, breed, and medical/behavioral conditions. Accepted forms of payment include cash, checks, or money order payable to Culpeper Humane Society. This adoption fee does not come close to what we have already happily invested in your future pet including: vet care for any medical issues (major and minor) the animal has when we first take possession, follow-up vet care, spay or neuter surgery, heartworm testing, heartworm and flea/tick preventative medication, vaccinations, deworming treatment, and microchips.

ONCE YOU HIT SUBMIT

We are an all volunteer group with full-time jobs and families of our own with no facility or dedicated phone number. All our animals are fostered in volunteer homes. Our usual response time is approximately 72 hours, but sometimes we are responding to reports of neglect, dog transports, medical assistance, etc and are unable to reply as quickly as we would like to respond. You will receive an immediate AUTO REPLY ON YOUR SCREEN that states WE RECEIVED YOUR APPLICATION after you hit the submit button. If after 72 hours, you have not been contacted, send us an email at info@culpeperhumanesociety.com checking in on progress on your application.