Adoption Application

Dog Information
Name of Dog*
Age of Dog*
Why do you believe the pet for whom you are applying would be a good match for your household?*

Contact Information
Applicant's Name*
First Last
Date of Birth*
MM slash DD slash YYYY

Please note: if you are over the age of seventy and wish to apply for a dog under the age of 3, you must have an approved co-applicant who can take over the care of the dog in the event it is needed
Cell Phone*
Home Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Co-Applicant's Name
First Last
Date of Birth
MM slash DD slash YYYY

Please note: if you are over the age of seventy and wish to apply for a dog under the age of 3, you must have an approved co-applicant who can take over the care of the dog in the event it is needed
Cell Phone
Home Phone
Email
Ages of children living full-time with you
Please note: CDHA will not adopt to families with children under the age of five years old)
Ages of children who frequently visit
Do they have familiarity with dogs? Explain

Dog Information

Age	Breed	Spayed / Neutered?