CRD Animal Adoption Application

First Name

Last Name

Address

City/Town

Province

Postal Code

Phone Number

Alternate Phone Number

Impound # (Animal Name)

Animal

Dog

Cat

Other:

Do you plan to have the cat declawed?

Yes

If yes, why?

Do you currently live in a

House

Apartment

Condo

Other:

Do you currently:

Rent

Own

Lease the residence where you live?

How long have you lived at your current residence?

Do you have a fully fenced yard?

Yes

Type and height of fence?

If not property owner, CRD Animal Care Services has my permission to verify current pet policy:

Landlord First Name

Landlord Last Name

Landlord Phone Number

How many adults live in your home?

How many children live in your home?

Child(ren) Ages

0-3

4-7

8-12

13-16

Does anyone in your household have allergies?

Yes

Who will be primarily responsible for the care of this animal?

Is this animal a gift?

Yes

If yes, for whom?

Which of the following best describes your reasons for wanting this animal? Check all that apply

What attracts you to the animal you are interested in?

This animal will be

Indoor only

Outdoor only

Indoor & Outdoor

Where will the animal be kept when no one is home?

How many hours per day will the animal be left alone?

Where will the animal be kept at night?

Have you had pets in the past as an adult?

Yes

Please list all of the pets you have had in the last 10 years including current pets, and those you no longer own

Please list all of the pets you have had in the last 10 years including current pets, and those you no longer own
	Species Breed Age Sex Yes No Altered Yes No Owned how long? What happened to him or her?	Item weight

more items

Do you currently have other pets?

Yes

Are their vaccinations current?

Yes

Are they currently licensed?

Yes

Do you have a regular veterinarian?

Yes

Veterinarian's Name

Under what circumstances would you not keep this animal?

How much money do you expect to spend per year caring for this animal (vet care, tags, food, supplies, toys)

Is there any other information you would like to add?

Personal information contained on this form is collected under the authority of the Local Government Act and is subject to the Freedom of Information and Protection of Privacy Act. The personal information will be used for purposes directly associated with this form. Inquiries about the collection or use of information in this form can be directed to CoralLee Henderson, Administrative Coordinator, CRD Animal Shelter, Capital Regional District 250.474.3351.

I certify that the information I have given is true and that I recognize that any misrepresentation of the facts may result in my losing the privilege of adopting an animal. I authorize investigation of all statements on this application. I understand

Abstract teal and navy blue butterfly illustrations.

Territorial Acknowledgement

The CRD conducts its business within the Territories of many First Nations, all of whom have a long-standing relationship with the land and waters from time immemorial that continues to this day. Statement of Reconciliation

CRD Animal Adoption Application

Feedback details

Territorial Acknowledgement