Crystal Coast Pet Rescue Adoption Application

This completed application will help us pick the best pet for you, your family and your lifestyle. It is very important that we find the correct home for every rescued pet. Please fill out all of the information requested. If you have questions about anything on this form please contact us at

Before filling out this form, please be sure you have read our adoption policies!
You must be over the age of 18 to be considered to adopt a pet
All of our animals are brought up to date on vaccinations, wormed, and will be spayed or neutered before going to their new homes.
There is an adoption fee that helps us offset the expense of veterinary care and getting these animals ready for new homes.

All fields marked with a * are required

Name of pet you are interested in:

*Your Name:   E-Mail Address:

*Address: *City: *State:

*Day phone: *Evening phone:

*What type of housing do you live in?

*Do you....Own Rent

If you rent, please provide a letter of permission from your landlord with telephone number

*How long at current address?

Do you have a fenced yard? Yes No
If No, do you plan on installing one? Yes No

*Number of children in home...
Child(ren) under 1
Child(ren) age(s) 1-3
Child(ren) age(s) 4-7
Child(ren) age(s) 7-10
Child(ren) age(s) over 11
Multiple items may be chosen.

*Does every family member agree to owning a pet?

Would you consider a special needs pet? Yes No

Do you have a pet sex preference? Doesn't matter Male Female

*How many hours will the pet be alone each day?
Your Occupation:

*Who will be primary caretaker of the pet?

*Where will the pet sleep at night?

*Where will the pet stay when no one is home?

*Will the pet live in your home? Yes No
If not, where?:

*How will pet be exercised?:

Please tell us about your pets
Pet 1
Name: Age: Breed:
¦Altered? Yes No N/A¦ ¦Declawed? Yes No N/A ¦ ¦Still Own? Yes No ¦
Pet 2
Name: Age: Breed:
¦Altered? Yes No N/A ¦ ¦Declawed? Yes No N/A ¦ ¦Still Own?Yes No ¦
Pet 3
Name: Age: Breed:
¦Altered? Yes No N/A ¦ ¦Declawed?Yes No N/A ¦ ¦Still Own?Yes No ¦
Pet 4
Name: Age: Breed:
¦Altered? Yes No N/A¦ ¦Declawed?Yes No N/A¦ ¦Still Own?Yes No ¦

What happened to the pets you no longer own?

*If you experience some behavioral problems with the adopted pet, how will you handle them?

*If you move, what will you do with your pet?

May we contact your vet?

If you are a first time pet owner you may leave this blank
*Vet's Name: Address: *Phone:

Please list the names and phone numbers of two (2) personal references (not related) that you have known
for at least two (2) years.

Reference 1
*Name: *Phone:  Email:

Reference 2
*Name: *Phone:  Email:

Are you willing to allow a CCHS representative visit your home as part of the adoption process? Yes No

Please tell us a little about yourself and why you feel you could provide a good home for this pet.

Please print a copy of this page for your records.
By submitting this application, you are certifying that all information submitted
is true and correct and that you are over the age of 18.