Chicago Canine Rescue Foundation
Dog Adoption Application
*Pet Name: Applicant's Last Name:
* Required field.
Please fill out application entirely. If the question does not apply and it is a required field, then put "N/A". We suggest using Internet Explorer to fill out this form. Thank you!
Applicant/Co-Applicant Information
*First Name: *Last Name: *Date of Birth:
First Name: Last Name: Date of Birth:
*Street address:
*Main Phone #: 2nd Phone #: 3rd Phone #:
How long have you lived at this address?
Do you own? Rent?
*Landlord's/Condo board's name/email/phone:
How were you referred to the Chicago Canine Rescue Foundation?
Family/Household Information
*Number of adults in the household: Relationships:
Have all the adults in the household agreed to this adoption? YesNo
*Number of children in the household: Ages of children:
Have the children had pets before? YesNo
*Is anyone in the household allergic to pets? YesNo
*Why would you like to adopt an animal from us? (Check all that apply)
Companion for self
Companion for child
Watch dog
Companion for another pet
Companion for another household member
Employment Information
*Employer: Position held:
Street address:
How long have you been with this employer? Work Phone:
Personal Reference Information
Please provide a personal reference other than a family member
*Name: *Phone Number:
Pet Information
Have you had pets in the past or do you currently have pets? Please tell us about them
*Have you had or currently have a pet(s)? YesNo
Name Breed Age Gender Altered Where are they?
*Have you ever given an animal away or relinquished an animal to a shelter? YesNo
*If yes, what were the circumstances?
*Do you currently have a Veterinarian? YesNo
If yes, below is required.
Veterinarian Information
Veterinarian's Name: Veterinarian's Phone:
When was your current pet's last visit to a veterinarian and why?
New Pet Information
*How long have you been looking for a pet?
*What will you feed your new pet?
How often will you feed your new pet?
*How much time are you prepared to allow for your new pet to adjust to your home?
*Are you able to afford a bill of $200-$400 (or more) for emergency veterinary care? YesNo
*How much do you expect to spend on maintenance for your pet in a year?
Are you committed to providing a responsible home for your pet's entire life (15+ years)? YesNo
If you have to move, what do you plan to do with your pet(s)?
*Who in the household will be the dog's primary care giver?
*Where will the dog be kept during the day? *During the night?
How many times per day do you plan to take your dog outside?
How do you plan to house train your dog?
Do you have a fenced in yard? YesNo
If yes, what size and what type?
*How many hours per day will your dog be left alone?
What would you do if your dog develops a problem with:

By hitting submit, I certify that the information I have given is true. I understand that the Chicago Canine Rescue Foundation reserves the right to deny my application for any reason. I further authorize the investigation of all statements in this application.

Thank you for your application,
The Chicago Canine Rescue Foundation