Adoption Application
Foster Application

Cosmo’s Cause Application for Adoption

Cosmo’s Cause Rescue and Retirement Sanctuary
P. O. Box 3
Monroe, VA 24574

A 501(c)3 organization

cosmozcause@gmail.com

"(Required)" indicates required fields

Name of the dog you'd wish to adopt(Required)

Date(Required)

Name of applicant(s)(Required)

Address(Required)

street please, no PO boxes City State ZIP Code

Phone Number(Required)

Email(Required)

Employers of any adults in the household:

Name

Number of work hours

Leave blank if none

Are you 21 years of age or older?(Required)

Yes

Do you rent or own your own home?(Required)

Yes, I rent

Yes, I own

Landlord Name

Landlord Phone

Have you adopted from us before?(Required)

Yes

Do you have other pets in your home?(Required)

Yes

Please list the names, ages and types of your pet(s).

Type

Name

Age

Leave blank if none

Are all of your current pets spayed or neutered?

Yes

Are all of your pets current with rabies vaccinations?

Yes

Name and contact information of your current and previous veterinarian(s):

Name

Phone Number

Leave blank if none

Have you lost a pet recently (in the last five years) or had to give one up for some reason?(Required)

Yes

Please Explain

What are you looking for in a dog?(Required)

What behaviors do you consider unacceptable?(Required)

What would you do if this dog develops a medical or behavioral problem that you cannot handle?(Required)

How many hours a day will your dog be home alone?(Required)

Please enter a number from 0 to 24.

Do you have a fenced in yard? (not required for adoption)(Required)

Yes

Will your dog be tied out during the day/evening?(Required)

Yes

How Long?

Where will this dog be when you are not at home(Required)

Reference Name(Required)

Personal reference who is not a family member and does not live with you:

Reference Phone #(Required)

Do you have any questions for us?(Required)

Any additional information you'd like to provide?

Leave blank if not

“I have never been convicted of animal cruelty. I certify that information entered on this application is true.”(Required)

I agree

Sign and Adopt(Required)

Today's Date(Required)

Cosmo’s Cause Rescue and Retirement Sanctuary

cosmozcause@gmail.com

Quick Links

Pet Application Form
Foods to Avoid Feeding Your Dog
501(c)3 Organization