A Program of the Central Pennsylvania Animal Alliance
	Application to Adopt Blue Pet's Name:  Date Applicant's Name  Address  City/State/Zip  Home Phone  Work Phone  Cell Phone  Email Address  How did you hear about Canine Rescue of Central PA? If you have children, please list how many and their ages. Have you ever owned a dog?          Yes          No If yes, please describe... Have you ever adopted from a rescue?          Yes          No If yes, please describe... Have you ever surrendered a pet to a shelter or another person(s)? Yes          No If yes, please describe... Do you currently have any pets in the home?     Yes          No If yes, please describe... If yes, what is your vet's name and phone number? Veterinarian   Phone   Are any of the pets listed maintained outdoors?     Yes          No If yes, please describe... Are the pets listed spayed or neutered?     Yes          No If no please describe... Do you have a fenced in yard?   Yes          No If yes, what type and how high?  Do you own or lease your home?  Own          Lease If you lease, is it an apartment or a house?    Apartment          House If you lease, are pets allowed?    Yes          No If yes, any breed/size restrictions?  No          Yes Note: We require supporting documentation in the form of a lease or letter from landlord permitting pets.
	Hounds of Prison Education A Program of the Central Pennsylvania Animal Alliance Site designed and maintained by: Quincy's Cafe all natural treats for your pet