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Chesapeake Bay Retriever Relief & Rescue
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Adoption Application
All steps must be completed before the application can be considered.
Welcome,
, to the
Initial
Adoption Application
This application is completed per the adoption status shown above. Would you like to adopt another dog?
Yes,
I
would like to adopt an additional Dog
You will need to resubmit a new application for a new dog, However, you won't need to reenter most previously entered home information.
You must, however, include any address, contact and other home changes since your last adoption with CBR&R.
You can also tell us about a prefered dog you'd like to adopt.
Finally, pay for and submit the application. Once submitted, a CBRR&R volunteer will assist you.
If your application is approved, we will send you an adoption contract for the new dog.
Create application for a new dog
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Verify Name of Applicant
Enter the Applicant's Name and Email(or Phone)
Lookup an existing Web Site user
If the applicant is already a registered user on the web site, the system can look them up and fill in their name and email
WP UserID
Get Web Site full name and email from the web site for this user
Enter or Edit User Info
Enter/Edit The full name of the User and either a Phone number or an email address. An email address is prefered. This will be the user application lookup key identifier, besides the automatically generated home ID
Email
Phone
First Name
Last Name
Save Step
Is your name above correct?
Please make changes to your Name and Profile in the
CBRR&R Web Site Profile
We found an incomplete existing application for
you
. Please complete this application.
Adoption Administration
Enter Dog Information
Create Adoption Contract
Home Notes
Age
What is
your
age?
We're sorry you must be 18 years-of-age or older to Adopt a Dog. However, your Parent or Guardian may do so.
Contact Information
Provide or verify your Address and Phone Contacts
Street Address 1
City
State
Zip
Country
Phone
Email
Provide or verify House Setting and Type. Also tell us whether you own or rent your home
House Setting
Own or Rent?
HomeType
Provide rental owner's name and phone:
Will you be moving soon?
Save Step
Confirm dog adoption ability
You'll be responsible for providing a good home for a dog
Agree to Costs
Pet ownership is a serious commitment that the entire household needs to consider and agree to before the animal is adopted. We want to ensure that each adoptive household is aware of, and willing and able to accept, the physical and financial responsibilities of pet ownership. Not everyone who desires to own a pet is ready to properly care for one.This questionnaire will assist both you and us in determining if your household is prepared to assume the role of responsible caretaker for a rescued animal.
Animals can be expensive to care for (estimated average annual cost is $750 for one dog). Are you willing and able to provide adequate food, shelter and medical care,including yearly checkups and vaccinations, for an adopted animal?
Provide References
Vet Name
Phone
2nd Vet Name
Phone
Reference
Phone
Reference
Phone
Save Step
Dog of Interest
Are there one or more available dogs on our web site you're interested in?
Select one or more dogs from our list of available dogs
Enter the dog's name or CBRRESCUE Dog ID in the search box below, and check the checkboxes in the results for the dog(s) you are interested in. If you don't know the name or ID, or wish to browse through our list of available dogs, you can scroll through the list of available dogs below, or you can visit our Available Dog Listing to do a full screen search for a dog in our public listings.
The Available Dogs you've selected are:
Please note your preferences so we can let you know when such an animal becomes available
Accept a Chessie Mix?
Sex
Age
Select preferred color(s)
Save Step
Deal with Dog or other adoption Problems
What Common Rescue Dogs Behaviors Will You Accept in a Rescue Dog? (check all that apply)
To help resolve problems, are you willing to:
Under what other possible circumstances would you return the animal: (check all that apply)
Save Step
Why adopt a dog?
Why are you considering adopting a dog? (check all that apply)
If considering adoption for another specific purpose, please specify:
Please explain in your own words why you are adopting a dog
Save Step
Dog Housing
Is Someone Home During the Day?
Where would the animal be primarily housed?
Where would the animal stay when you are not home? (check all that apply)
If the animal is outside other than for supervised activities, describe what shelter would be available for it: (check all that apply)
Yard information
Do you have a yard?
What Type?
Description
Height
Size(area)
# of Gates
Secured?
Save Step
Children
Children Living in the House
Number
ChildrenAges
Full time?
Children Visiting
Do other children visit?
Ages
How Often
Save Step
Home Environment
How many people are in your household?
Describe your home's activity level
Loud, Moderate or Quiet?
Occasional Guests?
Household Pet Allergies?
Provide swimming pool info (if any)
Do you have a pool?
What Type?
Fenced?
Are you willing to have a home visit
Save Step
Animals you already own
Have you ever owned a Chesapeake Bay Retriever before?
If yes, how many?
Please tell us the other Animals you already own
Other Dogs
Cats
Birds
What Other Types of Animals Do You Have?
Since you indicated you already own dogs, tell us more about them
Breed(s) other than Chessies
Owned For how long
Vaccinated?
Neutered?
No Heartworm?
Gender(s) (check all owned)
Other Health and Related Info about your other animals
Save Step
Comments
Comments
Please provide any additional thoughts regarding your adoption request
Save Comments
Confirm Application Fee
You cannot pay the fee until you've completed the other required application sections
Confirm Application Fee
There is a non-refundable adoption application donation of $10. to submit an application. This donation covers some of the costs associated with processing applications, maintaining our technology and new initiatives at CBRR&R. We cannot guarantee that we will have an available dog that matches your requirements or that your application will be processed in a specific time frame.
Pay with PayPal
Pay with a CBRR&R Discount Code
Enter CBRR&R Discount Code
Invalid Discount Code. Please reenter
Please Click on [Pay with PayPal] button to make your Donation, or if you were given a Discount Code from a CBRR&R representative click on the Pay with Valid Discount Code] button to enter code.
Only Applications with a paid application fee or valid Discount Code will be submitted for processing.
Save Step
Submit Application
Please complete the required application steps to continue
Please complete the payment step to continue
Application Submitted
I acknowledge that I completely read this questionnaire, comprehend it fully, know that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application or the adoption contract can result in the forfeiture of any CBR Relief & Rescue dog adopted by me.
Submit Application
Based on your answers to the questions flagged above, we're not able to complete your application form at this time.
Pay Pal Payment
Cancel
Close
By clicking the button below, You'll be shown a PayPal form to complete the Payment. This action will also submit your application.
Your application has been submitted and marked as complete. Thank you for chosing to adopt a dog from us.
(ID:
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Status:
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Basic Dog Information
Dog Name
Dog Class
Status
Removal Date
Removal Reason
Age
Sex
Weight
Color
Neutered
Housetrained
Heartworm Negative
Date Posted
Location
State
City
Region
Surrendered
Was a Surrender form received?
Surrender Form Date
Why Dog was placed into rescue
Reason
Other Reason-Please Describe
Vaccines
Health Conditions
Working Comments
Bitten
Bitten?
Bite Explanation
Behavioral Problems
Other Behavioral Comments
Good With
Likes
Commands
Tricks
OtherInfo
Contact
Contact
Phone
ContactEmail
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