Clark County Humane Society

Dog Adoption Application

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If you need us to email you the application, please ask!

If you need help with how to copy/paste, please click here for instructions:

                           HOW TO COPY & PASTE


Today's Date =

Name of pet(s) applying for (List in order of preference) =


Your Name =

Place of employment =

Drivers License =

Spouse (or significant other) name =

Spouse place of employment =

Drivers License =

Full names of all other adults in the home and relationship to you =

Name and age of children (full and part-time) =

Street Address =

City / State / Zip =

Mailing Address (if different) =

Home Phone Number =

Alternate Phone #1 (list whose) =

Email address(es) =


A) Reason(s) for wanting a dog (for kids, hunt, herd, protection, obedience, farm help, etc) =

B) Home is: Owned by me, Leased/Rented, Owned by parents =

C) Will this be an indoor or outdoor dog? =

D) When outside will dog be: in fenced yard (list type and height), loose/boundary-trained, leashed, kenneled (list size) =

E) Where will the dog be at night? =

F) Where will the dog be when you're not home? =

G) Will the dog be loose outside unattended? =

H) Describe exercise the pet will get =

I) Why is this particular pet a good match for you? =


List the vet clinic(s)(and phone#) you'll use for this pet =

If renting, you must bring written permission from your landlord or a copy of your rental agreement at the time of adoption.


Include for all cats and dogs in the format below:

Name / Breed / Age / Sex / neutered/spayed? / Yrs Owned / Where Acquired / Lives Indoors or Out

Pet 1 =

Pet 2 =

Pet 3 =

Pet 4 =

Pet 5 =


Include all cats and dogs in the format below:

Name / Breed / Age / Sex / neutered/spayed? / Yrs Owned / What happened to pet / How long ago / Indoors or Out

Pet 1 =

Pet 2 =

Pet 3 =

Pet 4 =

NOTE: Add more lines if needed for Current and Previous Pets. Failure to mention any dog or cat will cost you the adoption!


Returns are hard on pets and the family, so help us prevent them. To ensure this is a great match for you and your lifestyle, please tell us what you require in this dog. Expect at least a 30 day "adjustment period" for any pet.

A) Must it be good with strangers? (Not shy / Not Protective) =

B) Must it be good with dogs? =

C) Must it be good with cats? =

D) Must it be good with children? =

E) Must it be able to be loose unattended outside? =

F) Must it be potty trained within 30 days? =

Have you carefully read our entire Adoption Process? =

If approved, we require that you be able to pickup your new pet within one week. You must come during open hours. (Noon to 3 PM on Mon, Wed, Fri and Sat). Please pick a specific date =

We will email you (generally done in the evenings) to setup a time to meet and adopt the pet. If you're unable to check your email at night, let us know, otherwise please frequently check your email!

Please take a moment to be sure all questions were answered completely. As stated in the rules, mark "n/a" if a line does not apply. This is your one chance to impress us! The info you give us will make sure we're matching the right pet and right family together for a happy ending! Do you realize applications we feel are not complete cannot be processed? =

IMPORTANT! -- If we find a perfect home for a particular pet, we may cut off any further applications that have been started. You must sign/type your name below. In doing so, you are agreeing you've read our entire process and are swearing that all information you entered is correct. You also realize that by submitting your application, you are in no way guaranteed a pet. CCHS takes great pride in not just finding "a home", but a great home for each of our special pets. Rarely do we deny an applicant, so if you miss out on a pet, please do not think of yourself as being denied. With the pet's best interest in mind, as well as yours, we match people and pets together for long-term relationships and we'll try to help you find a great companion soon! CCHS has the right to deny any application, for any reason, at any time. =

Thank You For Considering One of our Special Pets!!


1-If renting, a copy of lease/landlord permission note when picking the pet up. Landlord signed permission note must include ALL things listed below (mark with N/A if no restriction)

     A - Your name, and rental address

     B - Number of pets allowed on property?

     C - Maximum Size of Dogs Allowed?

     D - What breeds not allowed?

     E - Are pets allowed inside the home?

     F - List any other restrictions

     G - Printed AND Signed landlord's name (include date signed)

     H - Landlord's contact phone number

2-Bring your drivers license

3-Cats must leave in a carrier, Dogs with a properly fitting leash/collar--NO EXCEPTIONS! (Shop in our store--all profits go directly back to the animals!)

4-Adoption fees may be paid by cash or credit card.  Checks are not accepted.


Adoption Fees are indicated in each animal's description on PetFinder.

FEE INCLUDES: Vet check, vaccinations (age appropriate), deworming, flea/ear mite treatment as needed,  blood test (age permitting) and spay/neuter surgery. All pets leaving CCHS are microchipped which includes a free ID tag and lifetime registration of the microchip. We provide an adoption folder with lots of helpful information.  You'll also receive a free 1 year subscription to our newsletter, Great & Small. In return, all we ask for are updates and photos to post on our walls!


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