Adoption Application | Coco's House Senior Sanctuary & Rescue

Coco’s House will contact your veterinarian and people listed for a character reference, as well as conduct a home check to verify and approve facilities and provisions made for the adoption of a rescue animal to be brought into your life.

Applicant understands and acknowledges that if for any reason they are unable to keep the adopted animal, arrangements must be made to return the animal to Coco’s House.

The undersigned attests that all information provided is true and accurate and understands that providing false or inaccurate information will result in nullification of this application and the applicant being disqualified for adoption.

Name*
First Last
MUST BE AT LEAST 21 YEARS OLD
Physical Address*
Street Address Address Line 2 City State ZIP Code
Occupants: How Many Adults?*
Occupants: How Many Children/Age(s)?
Home Phone
Mobile Phone*
Work Phone
Email*
Place of Employment
In Which Type of Animal Are You Interested?*
Applying for a Specific Dog?
If there is a particular pup you are interested in applying to adopt, please add the name here.
Qualities or Temperament Wanted:
Reason(s) for wanting to adopt?*
Other reason for wanting to adopt?
Please specify your reason here
Will the animal be kept inside or outside?*
If outside, must be kept in a fenced yard and provided with shelter (covered patio, size-appropriate dog house, etc) unless living on a farm or other large acreage where the animal will be away and safe from busy roads or highways so as not to be in danger of being hit by automobiles or possible abuse/harm from inconsiderate neighbors. If inside, considerations must be made for a fenced yard for outside exercise, walking on a leash, area to put food & water and where the animal will sleep.
Do you have other pets?*
If yes, please specify what and how many:
How many dogs?
How many cats?
Please specify what other type(s) of animal you have.
In the event of your absence:*
What arrangements will you make for your animal in the event of your absence or inability to care for it (e.g. vacation, medical reasons, etc.)? Please provide details:
Name of Veterinarian:*
Vet's Address:
Street Address City State ZIP Code
Vet's Phone:*
Character Reference #1*
First Last
List a person to be contacted for a character reference.
Phone*
Relationship:*
Character Reference #2*
First Last
List a person to be contacted for a character reference.
Phone*
Relationship:*
Character Reference #3*
First Last
List a person to be contacted for a character reference.
Phone*
Relationship:*
Consent*
I agree to all terms of this application
By checking this box, I agree to abide by all terms of this application. I am providing confirmation that I have read the terms provided and consent to Coco's House performing all aspects of the evaluation of my application to adopt a rescue animal in their care.