Phone: Cell Phone:
I own my own home
I rent a home
I have a yard that is completely
I rent an apartment
(Please answer if renting)
We require written authorization from the landlord verifying permission for
animal companions. This can be given at the home visit.
How long have you been at your current residence?
What type of fencing do you have?
have a pet. What type of pet?
I had a pet previously.
What type of pet did you previously have?
Female What was its
What happened to your previous pet(s)?
prepared to work with and train this animal.
How do you plan to discipline this animal?
willing to keep this animal for the length of its life.
(Answer if applicable)
May we call your veterinarian for a confidential reference check?
What kind of pet are you looking for now?
Name of the animal you would like to adopt:
Why do you want this kind of pet?
What will happen to this pet if it damages your property
or if you move?
Where will this animal be kept during the day?
During the evening?
How many people reside in your home?
I have children that reside in
my home. Ages?
afford to take care of this animal (food, vaccinations, licenses,
What is your place of employment?
How long have you been there?
Do you have any plans to move in the next 6 months?
Are you expecting any life changing events in the next 6
months (i.e. new family member)?
Would you like to receive our newsletters and be
notified of upcoming CPP events?
understand that if for any reason I can't keep this pet, Coalition guidelines
require the animal's return to CPP.
If for some reason this form does not work for you,
please e-mail: firstname.lastname@example.org
If you are not contacted within 24 hours, please call
the CPP hotline at 402-434-7922.