Welcome and thank you for visiting the Chula Vista Animal Care Facility!  We'll contact you within two business days on the status of your application. Our staff will be happy to answer any questions you might have.  Thanks again and we hope you find your new best friend!  

 Adoption Fee includes:

• Initial intake vaccines
• Microchip
• Rabies vaccine
• 1 year dog license (Chula Vista residents)
• Spay/Neuter surgery

The Chula Vista Animal Care Facility reserves the right to refuse adoption to any applicant. 

1

Type of animal you wish to adopt:

 *

Type of animal you wish to adopt:

Dog

Cat

Other If other, type text here.

2

Is this pet adoption:

Is this pet adoption:

You/Immediate Household

Someone Else

3

Your Information:

 *

Your Information:

First Name	Last Name
Co-owner First Name	Co-owner Last Name
Address	City
State	Zip
Home Phoneext.	Cell Phoneext.
Email	Unit/Apt. #

Household Information

4

Do you 

Do you

Own

Rent

Other If other, type text here.

5

If you do not own your home please provide the Landlord's information below:

If you do not own your home please provide the Landlord's information below:

Name	Phone Numberext.
Name of Apartment Complex or Mobile Home Park	Pet Deposit Required? Y/N

6

If you are planning to adopt a dog, do you have a fenced yard?  

If you are planning to adopt a dog, do you have a fenced yard?

Yes If other, type text here.

No

7

Number of adults in home

Number of adults in home

8

Number of children in home

Number of children in home

9

Age(s) of children

Age(s) of children

10

Any members of your household have allergies specific to animals? 

Any members of your household have allergies specific to animals?

Yes

No

11

Are all family members aware that you are considering adopting a pet? 

Are all family members aware that you are considering adopting a pet?

Yes

No

Pet History:

12

Do you own other pets? 

Do you own other pets?

Yes If other, type text here.

No

13

Please list the current pets residing at your home (including pets of roommates(s):

	Breed Type	Name	Age	Sex	Spayed/Neutered? Y/N	Owned for how long?	Indoors/Outdoors?
1	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):
2	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):
3	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):
4	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):
5	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):
6	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):
7	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):	Please list the current pets residing at your home (including pets of roommates(s):

14

Have you ever given up/given away a pet?  Y/N 

 *

Have you ever given up/given away a pet? Y/N

Have you ever given up/given away a pet? Y/N

If yes, please explain the circumstances:

New Pet Information:

15

Would you accept an animal that has a treatable medical condition? (common easily treatable conditions may include: tapeworms, upper respiratory and post surgical care)

Would you accept an animal that has a treatable medical condition? (common easily treatable conditions may include: tapeworms, upper respiratory and post surgical care)

Yes

No

16

Will the pet be kept:

Will the pet be kept:

Indoors

Outdoors

Both

17

Where will it sleep?

Where will it sleep?

18

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

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

19

Are you moving/relocating soon?

Are you moving/relocating soon?

Yes

No

20

Where will the pet spend most of its time? 

Where will the pet spend most of its time?

Crate

Indoors

Outdoors

Garage

Run

21

Please describe the daily routine of your newly adopted pet. This should include open door access to yards, how time is spent outdoors and exercise level expected.

Please describe the daily routine of your newly adopted pet. This should include open door access to yards, how time is spent outdoors and exercise level expected.

22

Other

If interested in any specific animal(s) please write in the Animal ID number or kennel number below

23

Declaration Under Penalty of Perjury

 *

Declaration Under Penalty of Perjury

I agree to waive and release the City of Chula vista, its elected and appointed officers, agents, employees and volunteers from and against any and all claims, demands, causes of action, costs, expenses (including reasonable attorney's fees and actual costs), liability, loss, damage, injury, illness, including wrongful death, in law or equity, concerning an animal I own or have custody or control of, my property, myself/heirs/executors/administrators, or to any minors in my company and their heirs/executors/administrators, arising from an interaction between my animal, myself, any minor in my company and an animal in the custody or control of the Animal Care Facility. I hereby agree to indemnify and hold harmless the City from and against any and all such claims, whether caused by negligence or otherwise. I understand and agree that by signing this waiver I am freeing the City, its employees, officers, agents and volunteers from any liability resulting from such activity. I recognize that animals may act in an unpredictable manner, and an interaction may be dangerous to people and/or animals, and I accept those dangers. I understand that if my animal(s) , any minor in my company, or I suffer injury, illness or loss during or after an interaction, this waiver will be used against me and anyone else claiming damages in any claim or legal action based on my, the accompanying minor's, or my animal's injury, illness or loss. I also understand that no City employee or agent is authorized to modify this waiver. I have personally read and understand this waiver. I am 18 years of age or older.

The adoption of an animal should never be impulsive, but rather a well thought-out decision made by the entire family or household and always with the best interest of the animal in mind. The goal of the Chula vista Animal Care Facility is to place animals into permanent, responsible homes. We will always choose the best possible home for each individual animal, based on the animal's needs and its potential home environment. I certify that the information given on this application is true and correct. If I am approved by the Chula Vista Animal Care Facility to adopt an animal, I agree to be responsible for providing proper shelter, food, water, exercise, medical care and humane treatment at all times. I understand that failure to comply with any of the requirements will result in confiscation of adopted animal.

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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