Adoption Application

Acknowledgement *

(I acknowledge)

By checking this box, I acknowledge that there is a non-refundable adoption fee of $350 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

NOTE: Verizon.net emails do not work! (Verizon Email Retirement). Please use an alternate email.

Cell 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.

Upload a copy of your lease agreement here, or email a copy to: codarnj@gmail.com

Click or drag a file to this area to upload.

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

In the event something were to happen to you, do you have a friend or relative that would assume responsibility of your pet(s)?

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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