Canine Adoption Application

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? *
Is there a specific animal you are interested in adopting? *
If there is a specific animal that you are interested in adopting, please select their name from the field below. Else leave the field below blank.
Please tell us which specific animal you are interested in adopting (Start typing the first letter of the name to shorten the list):
If you can't find the name of the specific animal you are interested in, please type it here.
If there is a not a specific animal you are interested in adopting. Please tell us a little about your preferences so we can match you with your perfect forever family member.
If the animal you are applying for is not available would you like us to match you with other animals?
If the animal you are looking for isn't available would you consider fostering? *
If the specific animal you are interested in adopting is not available can you please tell us a little about your preferences so we can match you with your perfect forever family member
Are you interested in a specific breed of dog? *
Select up to three different breeds of dog that you are looking for
Breed of Dog you are interested in adopting *
Second Breed of Dog you are interested in adopting
Third Breed of Dog you are interested in adopting
Have you ever owned the breed of dog you are applying for? *
Is there a specific age you are looking for? (Check all that apply) *
Is there a specific size/weight you are looking for?(Check all that apply) *
What sort of temperament are you looking for? (Check all that apply) *
Is there any other preferences you have about your potential pet you'd like to let us know about?
What are you NOT looking for in a dog? *

Adopter Information

First Name *
Last Name *
Age *
Date of Birth Ex: 4/22/78 *
Street Address * Ex. 123 Test St. Apt. 104
City *
State *
Zip Code *
Email Address *
Cell Phone * Ex. 123-456-7890
Home Phone Ex. 123-456-7890
Preferred method of contact * Select one
Have you been a CT resident for at least the last 5 years? *
If no, please advise prior state/s you resided in: Chose all that apply.
Home Information
How long have you lived at this address? (Years) * Years
Home Situation * Please select one.
If Other Please Describe
Do you own your current place of residence? * Select One
Please Note: If you are a renter, or live with someone else who owns the home, 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 an animal in your home.
Landlord/Parent Name (Parent info needed if applicant lives with Parents) *
Landlord/Parent Phone (Parent info needed if applicant lives with Parents) * Ex. 123-456-7890
Name of Condo Association Contact * If there is no association, please put N/A.
Phone number for Condo Association Contact * If there is no Condo Association please put N/A
Do you plan on moving? *
If yes, What will you do with your animals?
How many adults (over 18), other than yourself live in your home? (Please list full names & Date of Birth - ex: Joe Smith, 5/18/1955): *
(Please list full names & Date of Birth - ex: Joe Smith, 5/18/1955): *
Do any children under the age of 18 live in the house or come over regularly? *
Please list the names and ages of the children. * ex. Susan, 17
If you have children or regularly visiting children, is this their first experience with a dog?
What is the noise/activity level of your home? * Select one
Is everyone in your home aware that you are adopting? * Select one
Are any people in your home nervous or apprehensive of any type of dog? If yes, please explain: *
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? *

Canine Experience and Information

Have you ever adopted a dog from a rescue before? *
If yes, what rescue?
Why do you want to adopt a dog? *
Who will be the primary caregiver for your rescued dog? *
Do you currently have pets? *
How many pets do you have?
Name of Pet 1
Type of Animal(Dog,Cat,Bunny,etc)
Age of Pet 1
Name of Pet 2
Type of Animal (Dog,Cat,Bunny,etc)
Age of Pet 2 (in years)
Name of Pet 3
Type of Animal (Dog,Cat,Bunny,etc)
Age of Pet 3 (Years)
Name of Pet 4
Type of Animal(Dog,Cat,Bunny,etc)
Age of Pet 4 (Years)
If you have more than 4 animals please list their names, type, and age here.
Are all your pets spayed/neutered and up to date on all vaccines, if not please explain.
Did you have any pets in the last 5 years that you no longer have? *
List any and all pets that you have had in the past 5 years, and why you no longer have them. *
Have you taken a current or past pet to a vet in the last 5 years? *
How many vets do you currently use for your pets?
Please provide the name and number of you current or past veterinarian your animals have been cared for by. *Please contact your veterinarian, so we may obtain information on your animals, past and present.
Veterinarian Name *
Veterinarian Town and State
Veterinarian Phone * Ex. 123-456-7890
How many Animals do you have with this vet? *
Name of Animal 1 at Vet 1 *
Type of Animal 1 at Vet 1 (Dog, Cat, Bunny etc.) *
Name of Animal 2 at Vet 1
Type of Animal 2 at Vet 1 (Dog, Cat, Bunny, etc)
Name of Animal 3 at Vet 1
Type of Animal 3 at Vet 1 (Dog, Cat, Bunny, etc)
Name of Animal 4 at Vet 1
Type of Animal 4 at Vet 1 (Dog, Cat, Bunny, etc)
If you have more than 4 Animals with this vet please list their name and type here.
Please provide the name and number of you current or past veterinarian your animals have been cared for by. *Please contact your veterinarian, so we may obtain information on your animals, past and present.
Second Veterinarian Name
Second Veterinarian Town and State
Second Veterinarian Phone
How many Animals do you have with this vet?
Name of Animal 1 at Vet 2
Type of Animal 1 at Vet 2 (Dog, Cat, Bunny, etc)
Name of Animal 2 at Vet 2
Type of Animal 2 at Vet 2 (Dog, Cat, Bunny, etc)
Name of Animal 3 at Vet 2
Type of Animal 3 at Vet 2 (Dog, Cat, Bunny, etc)
Name of Animal 4 at Vet 2
Type of Animal 4 at Vet 2 (Dog, Cat, Bunny, etc)
If you have more than 4 Animals with this vet please list their name and type here.
Please provide the name and number of your current or past veterinarian your animals have been cared for by. *Please contact your veterinarian, so we may obtain information on your animals, past and present.
Third Veterinarian Name
Third Vet Address
Third Veterinarian Phone
Please list the names and types of all the animals at Vet 3
Please provide the name and number of your current or past veterinarian your animals have been cared for by. *Please contact your veterinarian, so we may obtain information on your animals, past and present.
Fourth Veterinarian Name
Fourth Vet Address
Fourth Veterinarian Phone
Please list the names and types of all the animals at Vet 4
Are there other pets in the house that belong to someone else? *
How many others pets live with you that don't belong to you?
Name of Other Pet 1
Type of Animal(Dog,Cat,Bunny,etc)
Age of Other Pet 1 (Years)
Name of Other Pet 2
Type of Animal (Dog,Cat,Bunny)
Age of Other Pet 2 (Years)
Name of Other Pet 3
Type of Animal(Dog,Cat,Bunny)
Age of Other Pet 3 (Years)
Name of Other Pet 4
Type of Animal(Dog,Cat,Bunny,etc)
Age of Other Pet 4 (Years)
Are the other pets in your home spayed/neutered and up to date on all vaccines, if not please explain.
have the other pets in the house that do not belong to you been to the vet?
Please provide the name and number of the current or past veterinarian the other animals in your home have been cared for by. *Please have the owner contact veterinarian, so we may obtain information on the animals.
Veterinarian Name
Veterinarian Town and State
Veterinarian Phone
What is your experience with dogs. Select all that apply * Select all that apply.
Where will your dog live? Select all that apply * Select all that apply
Please provide details about when your dog will be outside. Please select all that apply * Select all that apply
When will the dog be outside? (Select all that apply)
Will the dog ever by outside unsupervised? *
If yes, When / How?
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. Select all that apply * Select all that apply
Do you plan on having your puppy/canine's ears clipped or tail docked? * * Select one
Why or why not? *

How do you plan on grooming your dog? (Select all that apply) * Select all that apply
How often do you plan on taking your dog to the vet? Select all that apply * Select all that apply
Where will the dog be when you go on vacation/What arrangements will be made? *
What will happen to this dog if you are no longer able to care for him/her? (If a child develops allergies, you pass away, or other things one cannot control) *
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
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
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
Under what circumstances would you decide NOT to keep a pet? Select all that apply * Select all that apply

*Personal References* Phone number for each reference is required. Also providing an email address for each reference will help the approval process go faster. (Include at least one non-relative)

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

Canine Adoption Application Agreement

Please read these 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 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/or need assistance with my adopted canine. MHS will be here to discuss any concerns or issues that you may be having with your newly adopted family member.
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 *