Application For Adoption Thank you for your interest in rescuing a dog! Every CRCS dog comes with animal help, training tips, full access to our behavior specialist, and placement for the life of the dog. Ask for details. WE LOVE OUR DOGS! Please take a moment to fill out the following information. Interested in adopting: (dogs name and breed): To be considered as an adopter, you must: Be 18 years of age or older Have identification showing your present address Have the knowledge and consent of your landlord Be able and willing to spend the time and money necessary to provide medical treatment and proper care of the dog How did you find out about CRCS? Are you willing to have a representative of CRCS come to see where the dog will be living? Yes No If no, please explain: About You: Name: Spouse s name if married: Cell phone number: Phone (land line): E- mail:
Please provide two personal references: Name Relationship Street Address City State Zip Phone Email Name Relationship Street Address City State Zip Phone Email Where do you live? House Apartment Condo Mobile Home Other: Physical address: Will the dog live at this same address? Do you rent or own? If you rent, may we contact the owner to obtain permission for this dog to live in your home? Yes No Owner s name and phone number: How long have you lived at this address? Is the yard fenced? Are there stairs in your home or leading up to your home? Yes No If yes, how many?
How many dogs have you owned? List the traits you know about this breed: Are you willing to work with all traits associated with this breed? Have you ever turned your dog into a shelter? Yes No If yes, please explain: Is someone home during the day? Yes No If yes, who? How many hours each day will the dog be without human companionship? If you drive a pickup truck, would you allow your dog to ride in the back? Yes No If yes, please explain: About Your Household: Please list all adults and children that will be living with the dog and their age: Does everyone agree to adopt the new pet? Does anyone have pet allergies? Please list all other animals living inside the home and their age: Please describe what a typical day will be like for your new dog:
What is the intended purpose of adopting this pet? Where will you keep your dog while you are away? Are there times when your dog will be tied up? Yes No If yes, please explain: Will your dog spend any time in the garage? Yes No If yes, please explain: What type of activities do you and your family like to include your dog in? How much time will you devote to exercising and stimulating your dog every day? Where will your dog go if you move or in the case of an emergency? What is the name of your veterinary hospital? Can you afford veterinary bills should something come up? How much are you willing to spend in medical bills for your dog? Up to $100 Up to $500 Up to $1000 Up to $5000 Whatever it takes Still with us? GO YOU!!! All dog owners must have patience J
Adoption Fees: Puppies (age 0-6 months): $250 Puppies (age 7 months 1 year): $125 Desirable Breeds: $125 Adult Dogs (age 1-5): $100 Older and Wiser (age 6+): Donation in the amount of your choice. THANK YOU! Special Needs: Donation in the amount of your choice. THANK YOU! By signing below I agree to contact CRCS should I not be able to care for this dog in the way I had intended. I understand that CRCS is willing to help me do this. I also understand CRCS will want the dog back should I not be able to provide the correct environment for him/her, or follow this agreement that I am about to make. I understand that I am now the sole caregiver for this dog and it is my responsibility to protect him/her from environments that may be harmful to his/ her well- being. I am adopting a new family member and I will treat it as such. Your Signature Date www.crcsgiveslife.org (775) 800-1906 555 US Highway 395 North Washoe Valley, NV 89704