You're not only heroes to animals, you're heroes to all of us who care so deeply about animal welfare.


Please complete the adoption form:

Name *
Cell Phone *
Cell Phone
Home Number *
Home Number
Address *
Please list names, ages and breeds of all current pets.
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?
Please contact your vet to let them know that a CHS representative will be calling them for a reference and it is okay for them to talk to us.
How many adults in your household? How many children in your household? Ages of each child?
If yes, how many hours per day? Where will your pet spend his time while you are gone?
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?
How will your new pet get daily exercise? Where your your new pet sleep at night? How many hours will your dog spend outside per day? Do you have a fenced in yard? How will you confine your new pet to your property?
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?
If yes, how many litters per year?
If yes, please describe the circumstances.
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.