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Adoption Application

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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?
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?
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?
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
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.
Mow much you are willing to spend on your pet per year?
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.
Do you have a fenced in yard?
Please choose the type of energy level you are looking for in a pet:
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, 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.