Our MIssion:
Our MIssion:
A Non-Profit (501(c)(3) Organization, founded in 1998
Chama Valley Humane Society   ©  2014 - 2017   •  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
Your Information  
New Pet Owner Name or Authorized Person
Address
City, State, Zip
Phone
Email Address
   
Household Information  
How many adults are living in the household?
Do you have any children living in your household?
If yes, how many and what are their ages?
 
What animal are you interested in adopting from us?
Type of Animal   Dog     Cat
Gender   Male     Female
Name of Animal
Breed (if known)
Age
Why are you interested in adopting this animal?
Where will this adopted pet be kept?
   
Do you currently have any pets living at your home?
If Yes, please provide us with the following:  
  Type (Dog, Cat, etc.) Breed Gender Spayed/Neutered? Age
Pet #1
Pet #2
Pet #3
Pet #4
Pet #5

Have you owned any pets in the past (other than your current ones)?
If Yes, what happened to each of those pets?
   
Please give two references, preferably of 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.