Shares Adoption Questionnaire At which CHS location is the pet you're interested in adopting?(Required) Newington, 701 Russell Road Waterford, 169 Old Colchester Road Westport, 455 Post Road East All adoptions in Newington are started with an application in person. Please visit CThumane.org/Adopt to learn more about the adoption process.Contact InformationPlease provide the name or ID number for the available pet you are interested in adopting.(Required) Date(Required) MM slash DD slash YYYY Name(Required) Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Prefix First Last Spouse/Partner Name(Required) Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Prefix First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)Is this number a landline or cell phone?(Required)LandlineCellEmail(Required) Have you adopted from CHS in the past?(Required) Yes No Date of previous adoption: I am adopting this pet for:(Required) Myself My family My children Other If other, who are you adopting for?(Required) Adoption Fees:(Required) I have reviewed the following adoption fees.Canines: Puppies up to 6 months: $445* Dogs 7-12 months old: $275 Dogs 1-7 years old: $150 Dogs over 8 years old: $100 Felines: Kittens up to 6 months: $300 Cats 7-12 months old: $200 Cats 1-7 years old: $140 Cats over 8 years old: $80 Small Animals: Hamsters/mice/rats: $10 Guinea pigs: $25 Rabbits: $35 Ferrets: $70 Chinchillas: $100 Birds: Finches: $5 Doves $15 Parakeets: $15 Lovebirds (in pairs): $50 Cockatiels: $40 Exotic Types: MarketHouseholdNumber of adults(Required) Number of children(Required)012345+Children's ages(Required) Is anyone in the household allergic to:(Required) Dogs Cats Hay Other animals N/a If other, list animals:(Required) I live in a:(Required) House Duplex Condo Apartment Other If other, please describe:(Required) Do you own or rent where you live?(Required)OwnRentLandlord Name/Housing Complex:(Required) Landlord/Property Manager Phone Number:(Required)Are there pet policies or restrictions where you live?(Required)YesNoDescribe restrictions:(Required) Current PetsDo you currently have other pets at home?(Required)YesNoPlease tell us about any other pets that live in your home including their species, age, gender, spay/neuter status, etc.(Required)Previous pet experience:(Required)CAPTCHA Shares
