Animal Adoption Application Our Process Thank you for applying for adoption at Chicago Canine Rescue! We are committed to making matches between our adopters and our dogs that willl last a lifetime! Please take a few minutes to answer the following questions as honestly and completely as you can. The more information we have, the better match we can make! After you submit your application, a representative from CCR will contact you via email to discuss scheduling a meet with the your family and the dog(s) you are interested in. We attempt to respond to all new applications within 48 hours of receipt. Note that we do reserve the right to perform a home visit prior to adoption at the discretion of Chicago Canine Rescue. PLEASE READ THE FOLLOWING VERY CAREFULLY!* Are you ready to take your dog or puppy home in the next 72 hours? Do you have the approval of your entire household andlandlord? If you have a pet at home already, are they are up to date on all required vaccinations? If you feel that you can do all of the above, click on the button below to start the application process.*I am ready to adoptI am NOT ready to adoptVisit our HomepagePlease give the name(s) of any specific animal(s) you are interested in.*Have you and your household met the animal(s) yet?*YesNoApplicant's Name* First Last Are you at least 21 years old?*YesNoDate of Birth* Date Format: MM slash DD slash YYYY Primary Phone Number*Email* Enter Email Confirm Email Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Is there a Co-Applicant? (Spouse, partner, family member)*YesNoCo-Applicant's Name* First Last Relationship to ApplicantCo-Applicant's Date of Birth* Date Format: MM slash DD slash YYYY Co-Applicant's Phone Number*Co-Applicant's Email Address*How long have you been at your current address?*0 - 1 year1 - 5 yearsMore than 5 yearsTell us about your home*I/We own a single family homeI/We own a condo or townhomeI/We rent our homeLandlord's Name* First Last Landlord's Email Landlord's Phone*Contact Person's Name for Condo or Townhome Association* First Last Contact Phone*Association Email* How many adults in your household?*Have all the adults in the household agreed to this adoption?*YesNoNumber of children in the household?*Ages of children*Have the children had pets before?*YesNoIs anyone in the home allergic to pets?*YesNoPlease explain the allergies.*Why would you like to adopt an animal from us?*Name of Personal Reference* First Last Please list someone who can speak to your character and pet history like a friend or coworker. Personal references cannot be a family member, a person living in the same home as you, or a significant other.Phone Number of Reference*Email of Reference* Do you currently have any pets?*YesNoIf yes, please list the name, species/breed, and age of each pet currently in your home.*Are your current pets spayed or neutered?*YesNoIf no, please explain the circumstances.*Have you had any pets in the past?*YesNoIf yes, please list the name, species/breed, and age at passing of the last four pets you've owned.*Were your previous pets spayed or neutered?*YesNoIf no, please explain the circumstances.*How did you obtain your pets?*Do you currently have a veterinarian?*YesNoOther - explain belowIf you answered "Other" above, please explain your current relationship to a veterinarian.*Name of Current Veterinarian* First Last Current Veterinarian's Phone*Name of Past Veterinarian First Last If you do not currently have a vet, please provide the name of the vet you used most recently.Past Veterinarian's PhoneHave you ever given an animal away or relinquished an animal to a shelter?*YesNoIf yes, what were the circumstances?*How long have you been looking for a pet?*0 - 3 months3 - 6 monthsOver 6 monthsDescribe the kind of temperament you are looking for in a dog?*Are you looking for a particular breed? If so, which breeds and why?*What food (brand, type) do you plan to feed your pet?*How often will you feed your pet?*How much time are you prepared to allow for your new pet to adjust to your home?*Are you able to afford a bill of $500 (or more) for emergency vet care?*YesNoIf no, what is your plan to provide emergency care should the need arise?How much do you plan to spend on maintenance for your pet in a year?*Are you committed to providing a responsible home for your pet's entire life (15+ years)?*YesNoIf you have to move, what do you plan to do with your pet(s)?*What will you do with your pet(s) when you travel?*Who in the household will be the pet(s) primary care giver?*Where will the pet(s) be kept during the day?*Where will the pet(s) be kept during the night?*How many times per day do you plan to take your dog outside?*How do you plan to house train your dog?*Do you have a fenced in yard?*YesNoHow many hours a day will your pet be left alone?*Please enter a number from 0 to 24.How will you deal with possible digging?*How will you deal with possible barking?*How will you deal with possible chewing?*How will you deal with possible aggression?*Please provide any experience you have with pets, information you believe we should know, or any additional information you may have:Name of Applicant:* First Last By typing my first and last name into this box, I attest that the information above is true and accurate to the best of my knowledge.EmailThis field is for validation purposes and should be left unchanged. 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