Adoption Application

Please read our Disclaimer before filling out this application.

Before completing this application, please note that we require a non-refundable adoption donation that ranges from $200 to $500. (Click Here for more information about the adoption cost.) Our adoption donations cover the cost of rescuing canines from high kills shelters, including transportation, veterinary costs, feeding, supplies etc which are required to take care of our rescued animals. We are a 501 (c) (3) non-profit organization. Please realize that dogs need vet care throughout their lives, including yearly boosters, heartworm and flea/tick preventive meds, etc. Please consider all associated costs prior to completing an application for adoption. Please note, we cannot accept applications from individuals under 21 years of age. If the applicant is living with someone that owns the home, we request that the homeowner completes the application.

Please complete all sections of this application. Failure to do so may result in an automatic declination of the adoption application. A * indicates a required field.

Acknowledge *

(I acknowledge)

By checking this box, I acknowledge that there is a non-refundable adoption fee of $200 to $500.

Name of Animal you are interested in adopting:

If the animal you are applying for is no longer available, please list other dogs you might be interested in.

Are all family members in the household in agreement with adopting a pet?

Yes
No

Applicant's Full Name: *

Co-Applicant's Full Name:

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email: *

Email

Confirm Email

Phone

Applicant's Occupation:

Applicant - Name and Address of Employer:

Co-Applicant’s Occupation:

Co-Applicant - Name and Address of Employer:

Please list name and ages of all family members residing in your home:

Residence: Do you own or rent?

Own
Rent

If you rent, you will need to provide a copy of your lease agreement specifying that pets are permitted.

What type of housing?

House
Apartment
Condo/Townhouse
Mobile Home

Do you have a fenced in yard?

Yes
No

If yes, what type of fencing?

Pet History

Do you have current pets?

Yes
No

If yes, please list all current pets (include type, name, breed, age, sex):

Have all of your current pets been spayed or neutered?

Yes
No

Are all of your current pets up to date on dhlpp and rabies shots?

Yes
No

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 will the pet you are applying to adopt be left alone?

What provisions will be made for your pet when you go on vacation?

Would you leave a pet unattended in your yard when you are not home?

Yes
No

Vet Reference

Please provide the contact information for your veterinarian. If you are a first time pet owner, please list the vet you plan on using.

Vet Name:

Vet Address:

Vet Phone Number:

What name are the records under?

Personal References

Please provide names for two personal references, co-workers, friends or neighbors. Relatives CAN NOT be listed as a personal reference.

Reference #1 Name: *

Reference #1 Email:

Reference #1 Phone:

Relationship to applicant: *

Reference #2 Name: *

Reference #2 Email:

Reference #2 Phone:

Relationship to applicant: *

Signature

By signing below 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.

Please add codarnj@gmail.com to your safe list so you are able to receive communications from us. Some e-mail services may block as spam.

Signature:

By typing my name in the field, I am confirming that all information that I have provided is true and accurate.

Captcha *

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