Canine Companions Rescue Center

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Application

If you would like to meet one of our loving companions please complete the application below. You should hear from one of our adoption counselors by phone or email within 48 hours. If you don't hear from us, please feel free to call or email us. If you would like to see the contract we require our adopters to sign, you will find it on the Documents page.

If you have any problems completing this form please try a slightly more complex, but equally fast method which uses Microsoft Word. Save the applicationproblems file to your hard drive (do not open it from here), then open it in Word and fill in the fields. Save the file under any name you choose and attach the saved file to an email to ccrcdogs@ccrcdogs.com. If you have any questions please email us or call us at (248) 834-9419.

Date
Which dog are you interested in?
Primary Adopter
Secondary Adopter
Relationship to Primary Adopter
Street Address
City
State
Zip
Home Phone
Cell Phone
Drivers License Number
Expiration Date
Primary Adopter Employer
Occupation
Work Phone
e-mail Address
Friend/Relative we can contact if your dog is found
Phone
Are you 18 years or older?	yes no Not answered
How many adults reside in your home?
How many children reside in your home?
What are the ages of the children?
Do you..	Own Rent Live With Parents Not answered

Name of Landlord
Landlord's Phone
Do you live in a/an	Apartment House Condo Townhouse Trailer Park Not answered
I have/plan to have	Fenced Yard Tie Out Outdoor Run Invisible Fence Dog House Not answered
How many hours per day would the dog be left alone?
When the dog is not supervised it will be	Loose in House Crated in House Room in House Yard Garage Not answered
Have you owned a dog in your adult life?	yes no Not answered
Please list animals you've owned in the past five years, starting with current or most recent	Breed/Type Age M F Spayed/Neutered? Up to date on shots? Y N What happened to this pet?
	Breed/Type Age M F Spayed/Neutered? Up to date on shots? Y N What happened to this pet?
	Breed/Type Age M F Spayed/Neutered? Up to date on shots? Y N What happened to this pet?
	Breed/Type Age M F Spayed/Neutered? Up to date on shots? Y N What happened to this pet?
	Breed/Type Age M F Spayed/Neutered? Up to date on shots? Y N What happened to this pet?
Name of Veterinarian
City
Do you own a crate?	yes no Not answered
Are you willing to obtain a crate/kennel and crate train the dog?	yes no Not answered
Have you ever given an animal to a friend, shelter or pound?	yes no Not answered
If yes, please explain.
What would be unacceptable behavior in the dog?
To help us make the right match for you, please answer the following questions:
Gender Preference?	M F No Preference
Age Preference?	Young (Less than one year) Adult (1-8 years) Older Adult (Over 8 years) No Preference
Size Preference?	Lap Dog (under 10 lbs) Small Medium Large Massive No Preference
Preferred Breed(s)
My dog will need to get along with	Other dogs Cats Other animals
Our Housekeeping	Very Neat Neat but not immaculate Lived-in
Our Personality With Dogs	Very gentle Tolerant but we have rules Very firm
Our Household Is	Loud and chaotic People are usually around Very quiet
Is Anyone Nervous About Dogs?	Very We're not very experienced Not at all
I would accept a dog that: (please choose at least one from each group:	Is mellow/easygoing Is moderately active Is athletic/high-energy Loves everyone Prefers family Needs encouragement with strangers Is very affectionate Likes some affection Is more independent Is quiet Barks at times Is a "chatterbox" Is calm greeting people Is excited when greeting Is very excited when greeting Doesn't need much training Needs some basic training Needs ongoing training Needs little grooming Needs weekly grooming Needs daily grooming Likes to walk on leash Will run with me Wants to play and play Plays alone well Wants to be with me

Please Type Name (this will serve as your signature)

While we gather what we need for our new facility we don't want the dogs to have to wait, too. If you would like to help us by fostering a dog (or two or three), or you might like to foster a pregnant mother dog or a mom and a litter of puppies, please call (248) 834-9419 or write to us at ccrcdogs@ccrcdogs.com.

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