Adoption Application — Dogs and Puppies
THE ADOPTION FEE FOR DOGS AND PUPPIES IS $100.00

Thank you for taking the time to answer this application honestly. Our volunteers will make every effort to place a dog or puppy in your home that is the right fit for both you and the animal. Please include any additional information on this form that you think may help assure that one of our pets may be right for you. By submitting this on-line application form, you agree to allow Columbia Second Chance the right to contact your vet and other references to inquire about your status as a potential home for a CSC animal.

I. Tell us about yourself:

Your Name: *required
Your E-Mail Address: *required
Street address:
City: State: Zip:
Phone Numbers (plus area codes):
Day Evening Cell

How many hours a day are you away from home?
Are there children in your home? If yes, what are their ages?
Is acquiring a new dog a family decision?   
Should your current family/home situation change, will the pet be a part of that change?   

II. Tell us about your home:

What type of home do you have? 
Do you own or rent your home? Do you have roommates?
What size yard do you have?
Is your yard fenced?
Do you intend to use a pet door?
Where will your new dog sleep at night?
Where will your new dog stay while you're not at home?
For Renters: Landlord's name:
Landlord's phone number (plus area code):
Weight or size restriction for pets, if any:
Do you have a pet deposit? If you have a pet deposit, have you paid it?
Do you intend to be a single-pet family or multiple-pet family?

III. Tell us about your other pets (list the pets that you have had in the last five years or still have):

Name Type/Breed Age Sex Altered? Still Have? (If not, why?)

Are all your current pets up to date on their vaccinations?
Please give us your veterinarian’s name and phone number for confirmation:
Practice: Vet’s Name:
Vet's Phone (plus area code):


IV. We will need at least two (2) personal references and their phone numbers.

Name Phone (plus area code):

Name Phone (plus area code):

Is there a particular CSC dog (or breed/size) that are you interested in adopting? If so, please list:



Please include any additional information that you think may help assure that one of our pets may be right for you.


The *required information must be included to submit this adoption application form.

  Thank You!
This questionnaire helps us in placing the right dog or puppy with the right family. An improper placement, or one in which all the details are NOT known, can end tragically - usually for the pet. We look forward to meeting you in the near future.

If you will be mailing this form please mail it to:
Columbia Second Chance
P.O.Box 10186
Columbia, MO 65205