Canine Adoption Application

Canine Adoption Application_old

Thank you for your interest in adopting a canine. Adopters must be at least 21 years of age to adopt. Kindly fill out this application so that we may be able to properly assist you in your adoption. Please Note: Submitting an application does NOT guarantee you will receive a rescued canine. We reserve the right to deny anyone to adopt a canine without explanation. M.H.S. is selective in our placement to assure they are in their adoptive homes for the remainder of their lifetimes. Applications are usually processed within a week. However, it can take longer depending on verification of your veterinarian/landlord/references. Please note that applicants must call their veterinarian upon submission of the application to give their permission for the veterinarian to share information with us. Also, all sections of the application must be complete. If your release is not given to your vet, or you left parts of the application blank, then your application will NOT be processed.


Date *
If the animal you are applying for is not available, would you like us to keep your app on file for 6 months?
Breed of Canine you are interested in adopting?
If there is a specific animal you are interested in adopting (if applicable, start typing the first letter of the canine's name to shorten the list):
If the name of the canine cannot be found in the list above, please note it here:

First Name *
Last Name *
Date of Birth Ex: 4/22/78 *
Age *
Street Address * Ex. 123 Test St. Apt. 104
City *
State * Ex. CT
Zip Code *
Email Address *
Cell Phone * Ex. 123-456-7890
Home Phone Ex. 123-456-7890
Preferred method of contact * Select one
Driver's License Number & State
Have you been a CT resident for at least the last 5 years? *
If no, please advise prior state/s you resided in:

What type of home do you live in? * Select One	Own Home Own Condo Rented Home Rented Condo Rented Apartment Live With Parents Other
If you own your home, name and number of the home owner on the deed, so we can verify:
How long have you lived at this address? * Ex. 1yr 3mo

Please Note: If you are a renter, we will need your landlord's contact information so that we can call and verify the animal you wish to adopt will be accepted. We can also accept a lease agreement or notarized letter from your landlord stating you are allowed to have that type of animal in your home. We WILL NOT approve an application that we cannot verify landlord permission.

Landlord/Parent Name (Parent info needed if applicant lives with Parents). If doesn't apply, indicate N/A *
Landlord/Parent Phone (Parent info needed if applicant lives with Parents) If doesn't apply, indicate N/A * Ex. 123-456-7890
Name & Number of Condo Association contact
Do you plan on moving? If so, when? *
If yes, What will you do with your animals?

How many adults (over 18) live in your home? (Please list full names & Date of Birth - ex: Joe Smith, 5/18/1955): *
How many children (under 18) live in your home? (Please list names & Date of Birth - ex: Amy, 3/1/2015): *
Are there children that visit your home? (if yes, please list ages & how frequent they visit):
If you have children or regularly visiting children, is this their first experience with a dog?
Are any people in your home nervous or apprehensive of any type of dog? If yes, please explain:
What is the noise/activity level of your home? * Select one	Quiet/Few visitors Moderate/ Some visitors coming and going Active/Frequent visitors Very Active/Lots of noise and visitors
Why do you want to adopt a canine? * Select all that apply
Who will be the primary caregiver for your rescued canine? *
Is everyone in your home aware that you are adopting? * Select one
Please describe your work/school/activity schedule to help us understand how long the dog will be home alone each day: *
Does anyone in your home have allergies to animals? *

Experience and Information

Have you ever owned the breed of dog you are applying for? *
Have you ever adopted an animal from a rescue before? *
If yes, what rescue?
Have you ever surrendered any animal to a shelter, animal control, or humane society before? *
If yes, why?
Under what circumstances would you decide NOT to keep a pet? Select all that apply * Select all that apply
If you have any pets now, list the Breed, Name, Age, Spayed or Neutered. List Items: Labrador, Janey, 6yrs, Spayed
List any and all pets that you have had in the past 5 years, and why you no longer have them.

Please provide the name and number of you current or past veterinarian your animals have been cared for by. Also, list the name the account is under if it varies from the name on the application. *Please contact your veterinarian to release information, so we may obtain information on your animals, past and present.*
Veterinarian Name - If doesn't apply, indicate N/A *
Veterinarian Address
Veterinarian Phone - If doesn't apply, indicate N/A * Ex. 123-456-7890

What is your past experience with canines. Select all that apply * Select all that apply.

What are you looking for in your ideal canine? (Breed, Temperament, Age, Weight, etc.) *

What are you NOT looking for in a canine? (such as breed, disposition, temperament, behavior). Please list anything you DO NOT feel comfortable dealing with (food/toy protection, animal aggression, unsocialized dogs, dogs needing obedience training). *
Many dogs that come into shelters are placed because of some type of behavioral or training issue, that you the new owner will be taking responsibility of now to correct. Does this concern you? * Select one
Are you aware that often times dogs adopted from a shelter need work on housebreaking? If the dog adopted from MHS is in need of house-training (which could take a few months to correct), how would you deal with this issue? * Select all that apply
Where do you plan on keeping your canine? Select all that apply * Select all that apply
If you selected occasional supervised access outside, please select all that apply Select all that apply
When will the dog be outside? *
Will the dog ever be outside unattended? *
If yes, when?
Where will the dog be during the day *
Where will the dog be at night? *
Where will the dog be when you are not home? *
How do you plan on exercising your dog? * Select all that apply
Do you have any interest in further training with your dog? * Select all that apply

Do you plan on having your puppy/canine's ears clipped or tail docked? * Select one
Why or why not? * Note: MHS does not recommend surgically altering the appearance of a dog for non medical reasons.
Please note: MHS does not recommend surgically altering the appearance of a dog for non medical reasons.
How often do you plan on grooming your canine? * Select all that apply
How often do you plan on taking your canine to the vet? * Select all that apply
Where will the canine go when you are away for a weekend, or go on vacation? What arrangements will be made? *

Many times a dog can develop destructive behavior, especially when poorly exercised and un-stimulated. How would you plan on correcting this behavior? * Select all that apply

What will happen to this canine if you are no longer able to care for him/her? (If a child develops allergies, one passes away, or other things one cannot control) *

Do you have any additional comments or questions:

*Personal References* (Include at least one non-relative)

Personal Reference 1 Full Name *
Personal Reference 1 Phone Number *
Reference 1 relationship to applicant
Personal Reference 2 Full Name *
Personal Reference 2 Phone Number *
Reference 2 relationship to applicant

*Adoption Application Agreement*

Please remember that the adoption fee is not for the purchase of a dog, but rather to help offset & cover the medical costs of all the dogs in our care.
*Read the following statements carefully and type your initials if you agree to each:

I certify that I am at least 21 years of age and the information I have provided on this application is true. I also recognize that any misrepresentation or omission may result in the loss of privilege to adopt from the Meriden Humane Society.
Initial Here *

I understand that MHS has the right to deny any application, and even if I am applying for a certain canine I understand that canines are adopted to the best home and not first come, first serve basis. My application may still be approved but may be better suited for another canine.
Initial Here *

I understand that MHS is not able to guarantee the health or temperament of any canine, as many canines come in with unknown histories. These are traits that could change upon adoption and I take responsibility to care and address these issues if they do arise.
Initial Here *

I agree to make veterinary appointment to introduce our/my canine to our/my veterinarian, and to address any medical issues or concerns immediately.
Initial Here *

I agree to provide further training for my adopted canine, especially if it is recommended by MHS to do so.
Initial Here *

I also understand that anything could happen in life, and if I find that I am no longer able to care for my adopted canine, I agree to contact MHS by phone or email to discuss return, rehoming, or any assistance needed with my adopted pet. MHS will be here to discuss any concerns or issues that you may be having with your newly adopted family member.
Initial Here *

Obedience training outside the home: MHS suggests that EVERY dog, regardless of their age, be taken for obedience training outside the home. MHS believe that each rescued dog AND owner is always in need of training for the purpose of bonding and adapting to the new house rules and developing a communication/respect system that allows the dog to be successful in their new home.
Many types of training exist. We encourage you to find a professional trainer who teaches positive methods, uses treats for motivation, and who has experience using less restrictive methods (ie: easy walk harness, clicker, and/or other training devices). Simply, they work without having to use choke, pinch/prong, or shock collars, with no heavy yanking on the leash to get your dog to respond. This method works well on all breeds. Through patience, practice, and praise a dog learns & bonds with their owner.

I understand that if further training is REQUIRED by MHS for your adopted canine, MHS requires proof of registration within the first month of adoption.
Initial Here *

When you acquire a pet: You accept responsibility for the health and welfare of another living thing. You are also responsible for your pet's impact on your family, friends, and community. A pet will be a part of your life for many years. Invest the time and effort necessary to make your years together happy ones. When you choose a pet, you are promising to care for it for its entire life.

*Choose wisely, keep your promise, and enjoy one of life's most rewarding experiences!*
Applicant Signature *
Applicant Name *
Signature Date *