COHPBR Adoption Application

Today's Date*

MonthDayYear

What is the name of the dog you are interested in? Please say Any if you do not have a prefrence.

Full Name*

First NameLast Name

Birth Date*

MonthDayYear

E-mail

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

Are you a HOME OWNER?*

Are you renting or do you have HOA *

If you have Home Owners Association Rules and Restrictions Have you checked to ensure that there are NO BREED RESTRICTIONS OR WEIGHT RESTRICTIONS *

Landlord's Name

First NameLast Name

Landlord's Phone

Area CodePhone Number

OCCUPATION *

Employers Phone Number*

Area CodePhone Number

Who will be the primary caretaker of this dog?

Do you have children please list ages of your children. *

What level of supervision will the children have when with the dog?

Do you have pets now? Please tell us about the pets you currently own. Include the type, age, breed, and if they are spayed/neutered. How did you acquire them?Dominant? Submissive? Playful? Lazy?

Please tell us about other pets you have owned. For each pet, please include the following information: breed, age, length of ownership, how ownership ended. If the animal passed away, please include the cause of passing. If the animal was rehomed, please provide details.

Are you familiar with prevenative care for fleas/ticks intestinal parasites. and heartworms? Are you willing to pay for monthly prevenative costs?

Where will the dog be kept when you are home?

How many hours per day will the dog be left alone?

If you have other pets, how will they be managed when unsupervised?

How much do you plan on spending per month on the dog for health care prevenative, food, and toys?

Where will the dog stay when you are not home and the dog is alone.

If you have a fenced yard, please describe your fence. How high is it?What type of material? Wood? Chain Link?

Where will the dog sleep at night?

Personality you are seeking

What behaviors and Training are you ok with?

I do not want to train my dog or deal with behavioral issuesI am ok with potty training my new puppy or dog with helpful tips from COHPBRSeparation Anxiety is ok I can crate or kennel the dog or puppy or take him/her to doggy daycareFence Jumper ( The dog will be indoors anyway) I will supervise outside play and bathroom breaksA dog that needs to be the only dog ( There is only room for one dog in my life )Destructive Chewing I understand puppies can go through a teething stage and will provide toys and purchase bitter yucki can work on obedience training it will be a bonding experienceTerritorial Issues I will be assertive and sign up for training to establish strong leadership!I am willing to take on a special needs dog

Have you looked into a local obedience class? What company are you considering? *

Many dogs experience a transition period when brought into a new home. Some behavioral issues may arise while they are adjusting to their new home. Are there any behaviors that you are not willing to work with?*

Under what circumstances would you not be able to keep your dog?*

Do you currently have a veterinarian? If yes, please list the practice, Veterinarian's name, and phone number:*

What you will you do if the veterinary care goes over your budget?*

Has everyone in your family been included in the decision to adopt a dog?

Is there anything else you would like us to know about you?

How did you hear about us?

By checking each box, you agree to the adoption terms set forth by COHPBR.*

I understand that COHPBR reserves the right to refuse adoption at their discretion.I agree that the dog will be kept as a companion house pet. The dog will not be used in any medical experimentation or illegal activities.I agree not to sell, trade, transfer ownership, abandon, or dispose of this dog in any way, nor release the dog to any family member or friend, but rather if for any reason I am unable to keep this dog at any point in the future, to contact COHPBR to assist me in finding a new, appropriate home for this dog.I agree to allow COHPBR to examine the dog and his or her living conditions at any point in the future, and to relinquish the dog if the conditions are found unsatisfactory. I further agree that I will not house the dog outdoors, even if in accordance with state and local laws.I understand that COHPBR will contact the references I have provided. They may also schedule and conduct a home or property check and a criminal background check at their discretion.I agree that I have never been convicted of a crime involving the neglect, abuse or any other activity relating to an animal.I agree to abide by all state and local leash laws. As a responsible dog owner I will NEVER let my dog roam free.I absolve COHPBR from any and all liability relating to or resulting from the ownership of a dog adopted from them. Upon adoption, I agree to assume full responsibility for the dog and the dog's actions, including any and all damages done by the dog.I agree that the information I have provided in this application is true and I agree to abide by all the conditions listed above.

COHPBR Adoption Application

Adoption Agreement