Adoption Application

Animal you are interested in adopting

Applicant's First Name *

Applicant's Last Name *

Street Address *

City *

State *

Apartment Number (if applicable)

Zip Code *

Phone Number *

Email Address *

Date of Birth *

Drivers License Number *

How did you find out about us?

Do you own other pets at the current time? *

If yes, please list their names, breeds, and ages.

Are all of your pets spayed/neutered/fixed? *

Have you ever turned your dog or cat into a shelter? *

If yes, please explain?

Have you ever had a pet euthanized? *

If yes, please explain:

Do you own or rent your home? *

Please select your current residence type. *

If you answered "other" above, please explain here:

How long have you lived at this address?

If you rent, does your landlord and lease allow pets? *

Landlord Name

Landlord Phone

Including yourself, how many people live in your household? *

Please list the ages & relationship of those who live in your home. *

Is everyone in your household aware that you are planning to adopt a pet? *

Does anyone in your household have allergies to dogs/cats?

Employment Status

If you chose "other" above, please explain:

If you are employed, what is your current occupation?

On average, how many hours per day will your pet be left alone? *

Will this pet be predominantly living inside, outside, or both? *

Please provide a description of this pet's living conditions.

Do you have a completely fenced-in yard? If so, what kind of fence? *

Will you allow us to perform home checks? *

I hereby certify that my responses to the questions are true and correct to the best of my knowledge. *

I/We understand that The Churchill Foundation makes no guarantees or warranties regarding the health or temperament of this dog. I/We promise and agree to be solely responsible for this animal, and to indemnify and hold harmless The Churchill Foundation from any and all claims of liability for the conduct of this animal on or after the date of this adoption. This Release of Liability and Indemnification shall apply to all known, unknown and unanticipated damages resulting from my/our adoption, ownership or control of such animal. *

I/We hereby agree to contact TCF immediately or return the animal should any problems or emergencies arise resulting in relinquishment of the TCF animal. TCF animals are not to be relinquished to any other shelter, home or rescue group without the approval of TCF official representative. *

I/WE HEREBY ACKNOWLEDGE THAT I/WE HAVE READ AND UNDERSTAND THE ABOVE TERMS AND CONDITIONS AND WILL KEEP THE ANIMAL DESCRIBED HEREIN AS A FAMILY MEMBER. I/WE UNDERSTAND THAT THIS IS A BINDING CONTRACT ENFORCEABLE BY CIVIL LAW. *