The Chance FoundationChance sharing quality time with Carla

 

 

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Thank You for taking the time and showing the interest in submitting an application to adopt one or more of The Chance Foundation dogs available for adoption. There are two different ways that you can submit your application:

1. Complete the Questionairre below and select the submit button at the end of the form, or

2. Download the .pdf version of the Application; Print the form out; Complete the form and then Fax it to: 540.788.4987

The Chance Foundation Adoption Questionairre

If you need the Free Adobe Acrobat Reader to open the form you can download that here
 
THE CHANCE FOUNDATION ADOPTION QUESTIONAIRRE
   
Your Full Name:
Your E-Mail:
Dog You Are Interested In:

How Did You Hear About Us:
   
1. PERSONAL INFORMATION:
   
Drivers License # (Optional)
Address Where the Dog will Live (Include APT # if applicable):
City: State: Zip Code:
Your Home Phone #:
Your Employer:
Your Employer's Phone #:
Your Spouse's Name
Your Spouse's Employer:
Spouses Employer's Phone #:
   
2. REASONS FOR ADOPTION:
   
Why Have You Chosen to Adopt a "Chance Foundation" Rescue Dog?
Why Have You Chosen This Specific Dog?
There is a Non-Refundable Adoption Fee Determined by The Chance Foundation Staff. Is this Fee Acceptable to You?
 
   
3. HOUSING INFORMATION:
   

Where You Live, Do You:
Type of Dwelling:
If You selected "OTHER" as the Type of Dwelling, please Explain:
If You selected " RENT":
Landlords Information:
We will ask to be provided a copy of your lease
Landlord's Name:
Landlord's Phone #:
Do You Have a Fenced Yard?
    If YES, Height 
If You Do Not Have a Fence, How will You Provide Exercise and safety Outdoors for Your Dog?
   
4. FAMILY INFORMATION:
   
#of Adults in Household:1 
#of Children in Household: Ages of Children:
   
5. PET OWNERSHIP INFORMATION:
Please list all of the pets you have owned in the last 10 years. EXPLAIN what happened to them. Have you ever given away, sold or surrendered a pet? Under what circumstances?
 
Pet #1 Type:  Age:  Still with You:
If NOT, Please EXPLAIN What Happened to the Pet:
Pet #2 Type:  Age:  Still with You:
If NOT, Please EXPLAIN What Happened to the Pet:
 
Pet #3 Type:  Age:  Still with You:
If NOT, Please EXPLAIN What Happened to the Pet:
Pet #4 Type:  Age:  Still with You:
If NOT, Please EXPLAIN What Happened to the Pet:
If You are Presently using a Veterinarian, or Have used a Veterinarian in the Last 12 Months, Please enter their information. We Do Collect VET References
Veterinarian's Name:
Veterinarian's Phone #:
Please enter the Type / Kind of Medication Your Pet(s) are using:
Heartworm:
Flea Preventative:
   
6. LIFESTYLE INFORMATION:
   
How Many Hours are You Away from Home during an Average Work Day?
Do You, or Can You Come Home for Lunch?  
Is it Required that You Travel for Work? 
If You are Required to Travel, WHO will Provide Care for Your Pet, and HOW?
ALL of the DOGS We Place are INSIDE DOGS. None are to Live Outdoors on a Regular Basis. Is this ACCEPTABLE to you? 
Exercise is Very Important for a Healthy and Happy Dog! What Would You Do to Exercise this Dog?
Where will the Dog be Kept During the Day?
Where will the Dog be Kept During the Night / Sleeping?
Where will the Dog be Kept When No One is at Home?
What Happens to the Dog If You Move?
What Do You See as Normal Puppy / Dog Problems?
How Would You ENCOURAGE and REINFORCE Appropriate Behavior?
How Would You DISCOURAGE and/or PREVENT Inappropriate Behavior?
In Your Opinion, What Circumstances Justify "Getting Rid of a Pet?"
Have You or Anyone in Your Household ever been Convicted of Animal Cruelty, Neglect or Abandonment?
   
7. HEALTH INFORMATION / ISSUES:
   
Does Anyone in Your Household Have Allergies? (Please Explain in Detail)
Does Anyone in Your Household Have Asthma? (Please Explain in Detail)
Does Anyone in Your Household Have a Disability or Special Needs that We Should Know About? (Please Explain in Detail)
   
8. ESTIMATED ANNUAL COSTS:
The following questions are asked so that the propesctive adopter fully realizes what the cost and maintenance would be to have a dog in their home. Many prospective adopters are surprised at the cost of food, medical expenses, and grooming that are necessary to keep a dog in good health.
Please Estimate the Amount you think it will Cost Yearly for the following:
Food: $
Grooming: $
Veterinarian Care: $

 

  
ADDITIONAL INFORMATION:
   
Any Additional Comments You Would Like to Add:
   
ADOPTION AGREEMENT:
   
Important Information:
All Prospective Owners Must Read & Acknowledge the following:
 

These dogs are in a rescue group because for one reason or another previous owners no longer could or wished to care for them. The main purpose of The Chance Foundation is to find responsible and reliable homes for all dogs placed in their care. Adopting a dog is a very important decision and one that not only affects your family, but the dog you decide to adopt.

Millions of dogs are euthanized each year because people do not seriously consider the care and maintenance of animals. Time and attention are major factors that need to be considered when taking a dog into your home. Medical expenses can be costly. All the dogs in The Chance Foundation have been previously taken to a vet for an examination. Basic shots are given, and
spaying/neutering if necessary. If there are extenuating medical factors involved, all will be noted in the contract upon signing. It is the responsibility of the new owner to provide additional and maintenance vaccinations if/as necessary, and any preventative care required such as grooming, teeth cleaning, nail trimming, flea and heartworm preventative.

In addition it is the responsibility of the owner to provide the necessary training/reinforcement to integrate their new dog into their home. If behavior problem arises, the owner agrees to contact The Chance Foundation to discuss further training. The owner may also hire a trainer or enter the
dog into a training program that is not affiliated with The Chance Foundation, but must keep The Chance Foundation apprised of the animals progress. The Chance Foundation also Reserves the Rights to perform home inspections even after the dog is adopted.
 
You agree to have read and understood the above information by making that selection below. If you have any questions please feel free to contact us. We will be more than happy to help you.