Adoption Application

Welcome! We are pleased you are interested in adopting from us. We want you to have an excellent adoption experience and ask for your cooperation in filling out this application so we can ensure the animal you are interest in is the best fit for you, your home and your lifestyle.

Depending on your situation, approval could take up to 48 hours. Approval is needed before holds can be placed on any animal.

CBHS Policies:

You must have valid identification at the time of adoption.
You must have the financial and emotional stability to care for the pet for the rest of its life.
You must be 18 to adopt.
You understand CBHS has the right to refuse the adoption of any animal at any time.
If you rent, we reserve the right to call your landlord to verify that you are allowed to house a pet at your place of residence.
All adults and children in the home must meet an adoption candidate before an adoption takes place.

Initial here to verify that you have read and agree to accept and abide by the above policies

Applicant Information

Adopter First Name

Adopter Last Name

Adopter Age

Street Address

City

Zipcode

Main Phone

Secondary Phone (Optional)

Are you currently employed or have a source of income?

Yes
No

Pet Preferences

I'm here to find: (check all that apply)

House pet / Companion
Pet for my kids
Outside dog/cat
Watchdog
Friend for my pet
Hunting dog
Gift
Service/ESA
Barn cat
Other (please specify below)

Other details

Name of pet(s) you are interest in adopting

This animal is a

Dog
Cat
Other

Where did you see them?

Please describe the personality you look for in a pet:

Where will your pet spend the majority of its time?

In home
Outdoor tie-out
Outdoor kennel/dog house
Outdoor building (barn, garage, etc.)
Fenced in yard
Other

Where will the pet be kept when it is home alone?

How long will the pet be left alone on an average day?

Will you spay or neuter your pet?

Yes
No
Undecided

If NO or UNDECIDED, please explain

Situational Scenarios

If you noticed a new problem after adoption what would you do to resolve the following problem with your pet?

Housebreaking/not using the litter box?

Keeping the dog in your yard?

Continual barking/meowing?

Play Biting?

Scratching?

Destructiveness & Aggressiveness?

Would you treat a condition costing over $150 if diagnosed by a vet?

Yes
No

If no, please specify.

What circumstances might cause you to give up a pet?

How would you rehome a pet?

Home Information

How long have you lived at your current address?

Please list any previous addresses you have lived at in the past 5 years:

Do you own or rent?

Own
Rent
Live with parent/guardian

If you rent, please provide your land lord's name & phone number (REQUIRED)

What type of home do you live in?

HouseCondoMobile HomeApartmentFarmAcreageOther

Do you have a fenced-in yard?

Yes
No

If yes, please describe the material and height of the fence (6 ft chain link, etc.)

House Residents Information

Do any children live in your home?

Yes
No

If yes, please list names and ages

How many adults (18+), including yourself, live in your home?

1
2
3
4
5+

Please provide the names of any additional adults

Are any household residents planning to move in the next 1-2 years?

Does anyone in your home have allergies?

Yes
No

If yes, please specify

What types of pets live in your home?

Cat(s)
Kitten(s)
Dog(s)
Puppy
Small Animal(s)
None

Please list NAME, AGE, GENDER, and BREED of all animals in the household (including barn cats):

Are all of your animals spayed or neutered?

Yes
No

If no, please specify.

Are all of the pets listed above current on required vaccinations?

Yes
No

Please provide your veterinarian's name and phone number (If you do not have any pets, type "N/A")

If you have pets now, when did they last see a vet and why? (If you do not have any pets, type "N/A")

What other kinds of pets have you had experience with?

What happened to them?

Signature

Please review your application and make sure everything is correct.

By electronically signing below, you certify the information you provided in this application is true and correct to the best of your knowledge.

Please type your first and last name to electronically sign

Today's Date

Get in Touch

Cedar Bend Humane Society

1166 West Airline Highway
Waterloo, IA 50703-9634

Phone
319-232-6887

Fax
319-235-2597

Adoption Center Hours
Open daily: 12pm - 6pm

Intake Center Hours
Open daily: 9am - 5pm
Closed daily 12pm - 1pm for lunch

Waterloo Animal Control
319-883-0797

Cedar Falls Animal Control
319-291-2515