The Road Home Rescue Project Adoption Application

Adoption Preferences

Date

If the animal you are applying for is not available, would you like us to keep your application on file for 6 months?

Is there a specific animal you are interested in adopting?

Please tell us which specific animal you are interested in adopting

If the animal you are looking for isn't available, would you consider fostering?

Are you interested in a specific breed of dog?

Is there a specific age you are looking for?

Is there a specific size or weight you are looking for?

What sort of temperament are you looking for?

Are there any other preferences you'd like us to know about your potential pet?

What are you NOT looking for in a dog?

Adopter Information

First Name

Last Name

Age

Date of Birth

Street Address

City

State

ZIP Code

Email Address

Confirm email

Cell Phone

Home Phone

Preferred method of contact

Have you been a Connecticut resident for at least the last 5 years?

Home Information

How long have you lived at this address?

Home situation

Do you own your current place of residence?

Do you plan on moving?

How many adults over 18, other than yourself, live in your home?

Additional Adult 1 — Full Name and Date of Birth

Additional Adult 2 — Full Name and Date of Birth

Additional Adult 3 — Full Name and Date of Birth

Additional Adult 4 — Full Name and Date of Birth

Do any children under age 18 live in the house or visit regularly?

If yes, list the names and ages of the children

What is the noise/activity level of your home?

Is everyone in your home aware that you are adopting?

Are any people in your home nervous or apprehensive about any type of dog? If yes, please explain.

Describe your work, school, and activity schedule so we understand how long the dog will be home alone each day.

Does anyone in your home have allergies to animals?

Canine Experience and Information

Have you ever adopted a dog from a rescue before?

If yes, list the name of the rescue

Why do you want to adopt a dog?

Who will be the primary caregiver for your rescued dog?

Do you currently have pets?

Did you have any pets in the last 5 years that you no longer have?

List all pets you have had in the past 5 years and explain why you no longer have them.

Have you taken a current or past pet to a veterinarian in the last 5 years?

Are there other pets in the house that belong to someone else?

What is your experience with dogs?

Where will your dog live?

Please provide details about where the dog will be while outside.

When will the dog be outside?

Will the dog ever be outside unsupervised?

Where will the dog be during the day?

Where will the dog be at night?

Where will the dog be when you are not at home?

Which do you plan on doing with your adopted dog?

Do you plan on having your puppy or canine's ears clipped or tail docked?

Why or why not?

How do you plan on grooming your dog?

How often do you plan on taking your dog to the veterinarian?

Where will the dog be when you go on vacation, and what arrangements will be made?

What will happen to this dog if you are no longer able to care for them?

Life plan: provide the name and phone number of the person or people who will care for your pets if you are unable to.

Many shelter dogs need help with behavior or training issues. Does taking responsibility for correcting those issues concern you?

How do you plan on exercising your dog?

Are you interested in further training with your dog?

If your adopted dog needs house-training, how would you deal with the issue?

Under what circumstances would you decide NOT to keep a pet?

Personal References

Each reference must include a phone number. Providing an email address is strongly encouraged. Include at least one non-relative. References must live at a different address than the applicant.

Personal Reference 1 — Full Name *

Personal Reference 1 — Cell Phone Number *

Personal Reference 1 — Email Address *

Reference 1 — Relationship to Applicant *

Personal Reference 2 — Full Name *

Personal Reference 2 — Cell Phone Number *

Personal Reference 2 — Email Address *

Reference 2 — Relationship to Applicant *

Canine Adoption Application Agreement

Read each statement carefully and type your initials if you agree.

I certify that I am at least 21 years of age and that the information I have provided on this application is true. I recognize that any misrepresentation or omission may result in the loss of the privilege to adopt from The Road Home Rescue Project.

Initials *

I understand that TRHRP has the right to deny any application. Even if I am applying for a certain canine, I understand that canines are adopted to the best home and not on a first-come, first-served basis. My application may still be approved but may be better suited for another canine.

Initials *

I understand that TRHRP cannot guarantee the health or temperament of any canine because many canines arrive with unknown histories. These traits could change after adoption, and I take responsibility for caring for and addressing these issues if they arise.

Initials *

I agree to make a veterinary appointment to introduce my canine to my veterinarian and to address any medical issues or concerns immediately.

Initials *

I understand that circumstances can change. If I am no longer able to care for my adopted canine, I agree to contact TRHRP by phone or email to discuss returning the canine or obtaining assistance. TRHRP will be available to discuss concerns involving my newly adopted family member.

Initials *

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 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.

Applicant Signature *

Date Signed *