Dog Adoption Application Form (Page 2 of 2) in pdf

Animal Services receives over 1,000 lost dogs each year, most of which have NO tags and are NEVER reunited with their families.

To protect your new pet, are you willing to keep a collar and ID tag, rabies tag, and/or city license tags on your pet at all times?

Yes

Do you understand that adopted animals must be examined by a veterinarian within two business days of adoption?

Yes

No If yes what is your veterinarian’s name ______________ Hospital Name

Do you have a veterinarian now?

Yes

_______________________________

Do you understand the cost of owning a dog, including food, vaccinations, flea, and other medical costs

can be $ 500 - $1000 annually?

Yes

PLEASE COMPLETE THE FOLLOWING INFORMATION SECTION IF YOU OR YOUR SPOUSE IS IN THE MILITARY:

Military ID # _____________________ Current duty station ___________________________________________

How long will you/spouse be in the Military? ______________ Do you live in base housing?

Yes

What will you do with your pet if you are transferred? ___________________________________________________

By signing below, I acknowledge and certify that:

If for any reason you are unable to keep this dog, will you agree to return it to Chesapeake Animal Services? Initial(s)

Yes

I have never been convicted of any violation of an ordinance or statute enacted pursuant to animal abuse, neglect or cruelty.

Initial(s)

Yes

CAS makes NO GUARANTEES OR WARRANTIES REGARDING THE HEALTH OR TEMPERMENT OF ANY ADOPTED ANIMAL.

CAS is not responsible for any medical costs incurred by me on behalf of any adopted animal.

If I return an animal to CAS within 7 days after adoption, I am eligible for a full refund, providing that the animal has been examined

by a licensed veterinarian as per the adoption contract.

Every dog or cat that is adopted shall be sterilized, vaccinated against rabies, and implanted with microchip identification

prior to release for adoption by the Animal Services Unit, unless completion of such procedures would jeopardize the health

of the animal. Anyone who violates this requirement is subject to criminal and civil penalties.

Sec. 10-44.1.

Submitting an application is not a guarantee that an animal adoption will be approved. Any omission or falsification of

information on this document can result in denial of the application and/or return of the animal.

The information herein provided by me is true and correct, and CAS is authorized to verify such information as necessary.

Applicant’s signature_______________________________________________ Date ________________________

Agency Witness signature __________________________________________ Date ________________________

Agency Witness Initials Approved

Denied

CAS- Chesapeake Animal Services

The Approval of this adoption application will be based on what is in the best interest of our shelter animal(s)

Dog Adoption Application Form Page 2