Chillicothe Animal Shelter Online Adoption Form

LIVINGSTON COUNTY HUMANE SOCIETY

CHILLICOTHE ANIMAL SHELTER
1400 South Mitchell Road
Chillicothe MO 64601
660-646-1006
EMAIL

Thank you for your interest in a pet from Chillicothe Animal Shelter!
Please follow the steps below to submit your Application and Contract.

Below is our Online Adoption Application. Please fill out ALL questions on the application, missing information will NOT be processed and your application will not be approved. If you have any questions about the application, please call us at the number above between the hours of 9AM to 4PM, Monday through Saturday. Once your application has been submitted, it will be reviewed and we will be contacting you with your approval status. We ask that you understand that filling out an application does not guarantee that you will be able to adopt the animal you're interested in, nor does filling out an application guarantee that we will hold a particular animal for you. The application is the first step in the approval process, once its status has been determined, we will be in contact with you for further details and completion of the adoption process.

PLEASE READ THE FOLLOWING CAREFULLY! Once you have completed and submitted your Online Adoption Application, you will be redirected to our Online Adoption Contract. It is very important that you read this and fully understand our rules and policies, this is a legal and binding document. You will be asked to enter some basic information again and, as well, to electronically sign the Contract. If we do not receive the Adoption Contract with the Adoption Application, your Application cannot be processed. If you experience any problems with the redirect, you may return to this page and access the Adoption Contract manually by CLICKING HERE.

Thank you.
Chillicothe Animal Shelter

WWW.CHILLICOTHEANIMALSHELTER.COM

LIVINGSTON COUNTY HUMANE SOCIETY ONLINE ADOPTION APPLICATION

Please read carefully and provide all requested information. This is your Adoption Application.

Pets Name *
Pets Description (Ex: Lab Mix, Black, 6 Years) *
PERSONAL INFORMATION
Your Name *
Your Address *
City *
State *
Zip/Postal Code *
Your Phone Number *
E-mail Address: *
Drivers License Number *
Vehicle License Number *
Employer *
Employers Address *
City *
State *
Zip/Postal Code *
Employer Phone Number *
Length of Employment *
HOUSING/FAMILY INFORMATION
Residence (House, Apartment, Condo) *
Do You Rent Or Own Your Home? *	Own Rent
If You Rent, Please Provide Landlords Name
Landlords Phone Number
Does Residence Have a Yard? *	Yes No
If Yes, Is Yard Fenced?	Yes No
If Fenced, What Type of Fencing and How High?
Number of People Living At This Address *
Number of Adults *
Number of Children *
Number of Seniors *
Is Everyone In Family Agreed Upon Adopting Pet? *	Yes No
PET CARE INFORMATION
Pet Housing (Fenced Yard, Kennel, Kept In House, Etc) *
Will Pet Be Left Alone During the Day? *	Yes No
If Yes, Approx. How Many Hours?
What Provisions Will Be In Place if Pet Is Left Alone? (Crated, Kept in Fenced Yard, Kept In House, Etc)
Is Adopting This Pet A Lifetime Commitment For You? *
What Animals Do You Currently Own? *	Dog(s) Cat(s) None
DOGS CURRENTLY OWNED: Please Give Ages, Breeds, Sizes
CATS CURRENTLY OWNED: Please Give Breeds, Ages
Are All Currently Owned Pets Spayed/Neutered?	Yes No
If No, Please Tell Us Why
Have You Ever Given Up A Dog or Cat? *	Yes No
If Yes, Please Tell Us Why
Have You Ever Relinquished A Pet To A Shelter? *	Yes No
If Yes, Please Tell Us Why
VETERINARY INFORMATION
Veterinarians Name *
Veterinarians Address *
City *
State *
Veterinarians Phone *
REFERENCE
Name of Personal Reference *
Phone Number of Personal Reference *
SIGNATURE
I Certify That The Above Information is True and Accurate: Type Name *
OFFICE USE ONLY: Microchip Number

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