Name of Animal you are interested in adopting:
If the particular animal you are applying for were not available, would you consider another pet from us?
Yes No
If yes, please indicate name or breed interested in:
Is everyone in your household in agreement with adopting a pet?
Yes No
Applicant's Full Name: (*)
Please add a value for .
Spouse/Co-Applicant's Full Name:
Applicant's Email Address: (*)
is not a valid e-mail address.
Re-enter Email Address (*)
is not a valid e-mail address.
Applicant's Home Address: (*)
Please add a value for .
Home Phone Number:
Cell Number:
Work Number:
Applicant's Occupation:
Spouse/Co-Applicant’s Occupation:
Applicant - Name and Address of Employer:
Spouse/Co-Applicant - Name and Address of Employer:
Residence: Do you own or rent?
Own Rent
If you rent, you must provide your landlord's contact information so that we may verify that you are allowed a pet:
What type of housing?
Apartment House Condo Townhouse Trailer
If other: Please specify:
Do you have a yard and is it completely fenced?
Yes No
If yes, what type of fencing?
If no, how do you plan on exercising your pet?
Do you have children?
Yes No
If yes, please list names and ages of all children:
Are there any other individuals living at your residence?
Yes No
If yes, please list name, age and relationship to applicant:
Does anyone in your house have any allergies/asthma?
Yes No
If yes, please explain:
Do you have current pets?
Yes No
If yes, please list all current pets in household: Name, Sex, Breed, Age, Altered?
Have you had pets in the past? If so, how long have you owned and what is the reason for no longer owning?
How many hours per day will the pet be left alone?
What provisions will be made for your pet when you go on vacation?
Where will you keep this pet (indoors/outdoors)? Please specify details?
Would you leave a pet unattended in your yard when you are not home?
Yes No
How long have you been looking for a pet?
How did you hear about CODAR?
Where have you looked for a pet prior to contacting CODAR?
Are you planning to change residence in the near future?
Yes No
If yes, please specify details:
Do you understand all pets adopted from CODAR will have to be or have already been spay or neutered?
Yes No
Will you assume all financial responsibilities for the dog you adopt including inoculations, regular veterinary care, licensing, ID Tag and supplies required to care for the dog such as crate, leash, collars, dog bed, etc?
Yes No
Veterinary References:
Vet Name:
Vet Address:
Vet Phone Number:
Personal References: Please note relatives can not be used as a reference.An email address and/or phone number is REQUIRED! Reference #1:
Please add a value for Reference Name:.
Relationship to applicant: (*)
Please add a value for Relationship to applicant:.
Phone Number of Reference: (*)
Please add a value for Phone number of reference:.
Emaill Address of Reference: (*)
Reference #2:
Please add a value for Reference Name:.
Relationship to applicant: (*)
Please add a value for Relationship to applicant:.
Phone Number of Reference: (*)
Please add a value for Phone number of reference:.
Emaill Address of Reference: (*)
By signing or submitting application online for pet adoption, I further certify that the information I have provided on this form is true and accurate.
I understand and agree that falsification of any of the above information is grounds to disqualify my adoption application and nullify all adoption(s) and/or adoption agreements between the applicant and Codar. I certify that I am over 21 years of age.
Signature: By typing my name in the field, I am confirming that all information that I have provided is true and accurate.
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