Our MIssion:
Chama Valley Humane Society © 2014 - 2026 • All Rights Reserved
Website developed and maintained by
Website to the Rescue
Contact Info:
Ph: (
888) 666-0641
•
info@chamahumanesociety.org
ADOPTION APPLICATION
Prospective adopters: please complete the following information
Our MIssion:
All Fields are REQUIRED
Date of Application
New Pet Owner Name or Authorized Person
Address:
City:
State:
Zipcode:
Phone Number:
Email Address:
PERSONAL / HOUSEHOLD INFORMATION
How many adults are living in your household?
Do you have any children living in your household?
Please Select One
Yes
No
If Yes, how many and what are their ages?
INTERESTS
Type of Animal:
Please Select One
Dog
Cat
What animal are you interested in adopting from us?
Gender:
Please Select One
Male
Female
No Preference
Name of Animal:
Breed (if known):
Age Range:
Why are you interested in adopting this animal?
Where will this adopted pet be kept?
Please Select One
Inside
Outside
Both
PET HISTORY
Do you currently have any pets living at your home?
Please Select One
Yes
No
If no current pets,
CLICK HERE
to jump to next question.
If Yes, please provide us with the following information for each pet:
Current Pet #1
Type (Dog, Cat, etc.)
Breed
Gender
Please Select One
Male
Female
Spayed / Neutered?
Please Select One
Yes
No
Age
Current Pet #2
Type (Dog, Cat, etc.)
Breed
Gender
Please Select One
Male
Female
Spayed / Neutered?
Please Select One
Yes
No
Age
Current Pet #3
Type (Dog, Cat, etc.)
Breed
Gender
Please Select One
Male
Female
Spayed / Neutered?
Please Select One
Yes
No
Age
Current Pet #4
Type (Dog, Cat, etc.)
Breed
Gender
Please Select One
Male
Female
Spayed / Neutered?
Please Select One
Yes
No
Age
Current Pet #5
Type (Dog, Cat, etc.)
Breed
Gender
Please Select One
Male
Female
Spayed / Neutered?
Please Select One
Yes
No
Age
Have you owned any pets in the past (other than your current ones)?
Please Select One
Yes
No
If Yes, what happened to each of those pets?
REFERENCES
Please give two references, preferably of whom is a veterinarian or other animal professional (groomer, trainer, etc). We must have valid phone numbers and/or email contacts.
Reference #1
Name:
Relationship:
Phone:
Email:
Reference #2
Name:
Relationship:
Phone:
Email:
BY CHECKING THIS BOX, YOU CERTIFY THAT ALL OF THE INFORMATION I HAVE PROVIDED ON THIS APPLICATION IS, TO THE BEST OF MY KNOWLEDGE, TRUE AND COMPLETE. I UNDERSTAND THAT FALSIFYING ANSWERS ON THE APPLICATION, OR AT ANY OTHER TIME DURING THE FOSTERING PROCESS, DISQUALIFIES ME FROM FOSTERING.
To help reduce Spam, please enter the TYPE of animal shown in the picture above
(all lower case)
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