Date *
If the animal you are applying for is not available, would you like us to keep your app on file for 6 months? *
No Yes
Is there a specific animal you are interested in adopting? *
No Yes
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):
Athena (Dog - D2024020)
Bailey (Dog - D2021024)
Blue (Dog - D2024081)
Buster (Dog - D2024079)
Corey (Dog - D2024058)
Dexter (Dog - D2024083)
Diesel (Dog - D2024053)
Grace (Dog - D2022045)
Hannah (Dog - D2023025)
Honey (Dog - D2024049)
Jax (Dog - D2024086)
King (Dog - D2024065)
Lady (Dog - D2023010)
Layla (Dog - D2021004)
Logan (Dog - D2023017)
Lucky (Dog - D2023019)
Mae (Dog - D2024074)
Mya (Dog - D2024075)
Nash (Dog - D2024067)
Nola (Dog - D2024084)
Rocky (Dog - D2024085)
Smokee (Dog - D2024076)
freye (Dog - D2024078)
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?
No Yes
If the animal you are looking for isn't available would you consider fostering? *
No Yes
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? *
No Yes
Select up to three different breeds of dog that you are looking for
Breed of Dog you are interested in adopting *
1.N/A
Abyssinian
Affenpinscher
Afghan Hound
Airedale Terrier
Akbash
Akita
Alaskan Malamute
American Bulldog
American Curl
American Eskimo Dog
American Shorthair
American Staffordshire Terrier
American Water Spaniel
American Wirehair
Anatolian Shepherd
Appenzell Mountain Dog
Applehead Siamese
Australian Cattle Dog/Blue Heeler
Australian Kelpie
Australian Shepherd
Australian Terrier
Balinese
Basenji
Basset Hound
Beagle
Bearded Collie
Beauceron
Bedlington Terrier
Belgian Shepherd Dog Sheepdog
Belgian Shepherd Laekenois
Belgian Shepherd Malinois
Belgian Shepherd Tervuren
Bengal
Bernese Mountain Dog
Bichon Frise
Birman
Black and Tan Coonhound
Black Labrador Retriever
Black Mouth Cur
Bloodhound
Bluetick Coonhound
Bobtail
Bombay
Border Collie
Border Terrier
Borzoi
Boston Terrier
Bouvier des Flanders
Boxer
Boykin Spaniel
Briard
British Shorthair
Brittany Spaniel
Brussels Griffon
Bullmastiff
Bull Terrier
Burmese
Burmilla
Cairn Terrier
Calico
Canaan Dog
Canadian Hairless
Cane Corso Mastiff
Carolina Dog
Catahoula Leopard Dog
Cattle Dog
Cavalier King Charles Spaniel
Chartreux
Chesapeake Bay Retriever
Chihuahua
Chinchilla
Chinese Crested Dog
Chinese Foo Dog
Chocolate Labrador Retriever
Chow Chow
Clumber Spaniel
Cockapoo
Cocker Spaniel
Collie
Coonhound
Corgi
Cornish Rex
Coton de Tulear
Crossbreed
Cymric
Dachshund
Dalmatian
Dandi Dinmont Terrier
Devon Rex
Doberman Pinscher
Dogo Argentino
Dogue de Bordeaux
Domestic Long Hair
Domestic Medium Hair
Domestic Short Hair
Dutch Shepherd
Egyptian Mau
English Bulldog
English Cocker Spaniel
English Coonhound
English Pointer
English Setter
English Shepherd
English Springer Spaniel
English Toy Spaniel
Entlebucher
Eskimo Dog
Exotic Shorthair
Extra-Toes Cat (Hemingway Polydactyl)
Field Spaniel
Fila Brasileiro
Finnish Lapphund
Finnish Spitz
Flat-coated Retriever
Foxhound
Fox Terrier
French Bulldog
German Pinscher
German Shepherd Dog
German Shorthaired Pointer
German Wirehaired Pointer
Glen of Imaal Terrier
Golden Retriever
Gordon Setter
Great Dane
Greater Swiss Mountain Dog
Great Pyrenees
Greyhound
Havana
Havanese
Himalayan
Hound
Hovawart
Husky
Ibizan Hound
Illyrian Sheepdog
Irish Setter
Irish Terrier
Irish Water Spaniel
Irish Wolfhound
Italian Greyhound
Italian Spinone
Jack Russell Terrier
Japanese Bobtail
Japanese Chin
Javanese
Jindo
Kai Dog
Karelian Bear Dog
Keeshond
Kerry Blue Terrier
Kishu
Komondor
Korat
Kuvasz
Kyi Leo
Labrador Retriever
Lakeland Terrier
Lancashire Heeler
Leonberger
Lhasa Apso
Lowchen
Maine Coon
Maltese
Manchester Terrier
Manx
Maremma Sheepdog
Mastiff
McNab
Miniature Pinscher
Mountain Cur
Mountain Dog
Munchkin
Munsterlander
Neapolitan Mastiff
Newfoundland Dog
New Guinea Singing Dog
No Preference
Norfolk Terrier
Norwegian Buhund
Norwegian Elkhound
Norwegian Forest Cat
Norwegian Lundehund
Norwich Terrier
Nova Scotia Duck-Tolling Retriever
Ocicat
Old English Sheepdog
Oriental Long Hair
Oriental Short Hair
Oriental Tabby
Otterhound
Papillon
Patterdale Terrier (Fell Terrier)
Pekingese
Persian
Peruvian Inca Orchid
Petit Basset Griffon Vendeen
Pharaoh Hound
Pit Bull Terrier
Pixie-Bob
Plott Hound
Pointer
Polish Lowland Sheepdog
Pomeranian
Poodle
Portugese Podengo
Portuguese Water Dog
Presa Canario
Pug
Puli
Pumi
Ragamuffin
Ragdoll
Rat Terrier
Redbone Coonhound
Retriever
Rhodesian Ridgeback
Rottweiler
Russian Blue
Saint Bernard St. Bernard
Saluki
Samoyed
Schipperke
Schnauzer
Scottish Deerhound
Scottish Fold
Scottish Terrier Scottie
Sealyham Terrier
Selkirk Rex
Setter
Shar Pei
Sheep Dog
Shepherd
Shetland Sheepdog Sheltie
Shiba Inu
Shih Tzu
Siamese
Siberian
Siberian Husky
Silky Terrier
Singapura
Skye Terrier
Sloughi
Smooth Fox Terrier
Snowshoe
Somali
South Russian Ovcharka
Spaniel
Sphynx (hairless cat)
Spitz
Staffordshire Bull Terrier
Swedish Vallhund
Terrier
Thai Ridgeback
Tibetan Mastiff
Tibetan Spaniel
Tibetan Terrier
Tiger
Tonkinese
Tosa Inu
Toy Fox Terrier
Treeing Walker Coonhound
Turkish Angora
Turkish Van
Vizsla
Weimaraner
Welsh Corgi
Welsh Springer Spaniel
Welsh Terrier
West Highland White Terrier Westie
Wheaten Terrier
Whippet
White German Shepherd
Wire-haired Pointing Griffon
Wirehaired Terrier
Xoloitzcuintle/Mexican Hairless
Yellow Labrador Retriever
Yorkshire Terrier Yorkie
Second Breed of Dog you are interested in adopting
1.N/A
Abyssinian
Affenpinscher
Afghan Hound
Airedale Terrier
Akbash
Akita
Alaskan Malamute
American Bulldog
American Curl
American Eskimo Dog
American Shorthair
American Staffordshire Terrier
American Water Spaniel
American Wirehair
Anatolian Shepherd
Appenzell Mountain Dog
Applehead Siamese
Australian Cattle Dog/Blue Heeler
Australian Kelpie
Australian Shepherd
Australian Terrier
Balinese
Basenji
Basset Hound
Beagle
Bearded Collie
Beauceron
Bedlington Terrier
Belgian Shepherd Dog Sheepdog
Belgian Shepherd Laekenois
Belgian Shepherd Malinois
Belgian Shepherd Tervuren
Bengal
Bernese Mountain Dog
Bichon Frise
Birman
Black and Tan Coonhound
Black Labrador Retriever
Black Mouth Cur
Bloodhound
Bluetick Coonhound
Bobtail
Bombay
Border Collie
Border Terrier
Borzoi
Boston Terrier
Bouvier des Flanders
Boxer
Boykin Spaniel
Briard
British Shorthair
Brittany Spaniel
Brussels Griffon
Bullmastiff
Bull Terrier
Burmese
Burmilla
Cairn Terrier
Calico
Canaan Dog
Canadian Hairless
Cane Corso Mastiff
Carolina Dog
Catahoula Leopard Dog
Cattle Dog
Cavalier King Charles Spaniel
Chartreux
Chesapeake Bay Retriever
Chihuahua
Chinchilla
Chinese Crested Dog
Chinese Foo Dog
Chocolate Labrador Retriever
Chow Chow
Clumber Spaniel
Cockapoo
Cocker Spaniel
Collie
Coonhound
Corgi
Cornish Rex
Coton de Tulear
Crossbreed
Cymric
Dachshund
Dalmatian
Dandi Dinmont Terrier
Devon Rex
Doberman Pinscher
Dogo Argentino
Dogue de Bordeaux
Domestic Long Hair
Domestic Medium Hair
Domestic Short Hair
Dutch Shepherd
Egyptian Mau
English Bulldog
English Cocker Spaniel
English Coonhound
English Pointer
English Setter
English Shepherd
English Springer Spaniel
English Toy Spaniel
Entlebucher
Eskimo Dog
Exotic Shorthair
Extra-Toes Cat (Hemingway Polydactyl)
Field Spaniel
Fila Brasileiro
Finnish Lapphund
Finnish Spitz
Flat-coated Retriever
Foxhound
Fox Terrier
French Bulldog
German Pinscher
German Shepherd Dog
German Shorthaired Pointer
German Wirehaired Pointer
Glen of Imaal Terrier
Golden Retriever
Gordon Setter
Great Dane
Greater Swiss Mountain Dog
Great Pyrenees
Greyhound
Havana
Havanese
Himalayan
Hound
Hovawart
Husky
Ibizan Hound
Illyrian Sheepdog
Irish Setter
Irish Terrier
Irish Water Spaniel
Irish Wolfhound
Italian Greyhound
Italian Spinone
Jack Russell Terrier
Japanese Bobtail
Japanese Chin
Javanese
Jindo
Kai Dog
Karelian Bear Dog
Keeshond
Kerry Blue Terrier
Kishu
Komondor
Korat
Kuvasz
Kyi Leo
Labrador Retriever
Lakeland Terrier
Lancashire Heeler
Leonberger
Lhasa Apso
Lowchen
Maine Coon
Maltese
Manchester Terrier
Manx
Maremma Sheepdog
Mastiff
McNab
Miniature Pinscher
Mountain Cur
Mountain Dog
Munchkin
Munsterlander
Neapolitan Mastiff
Newfoundland Dog
New Guinea Singing Dog
No Preference
Norfolk Terrier
Norwegian Buhund
Norwegian Elkhound
Norwegian Forest Cat
Norwegian Lundehund
Norwich Terrier
Nova Scotia Duck-Tolling Retriever
Ocicat
Old English Sheepdog
Oriental Long Hair
Oriental Short Hair
Oriental Tabby
Otterhound
Papillon
Patterdale Terrier (Fell Terrier)
Pekingese
Persian
Peruvian Inca Orchid
Petit Basset Griffon Vendeen
Pharaoh Hound
Pit Bull Terrier
Pixie-Bob
Plott Hound
Pointer
Polish Lowland Sheepdog
Pomeranian
Poodle
Portugese Podengo
Portuguese Water Dog
Presa Canario
Pug
Puli
Pumi
Ragamuffin
Ragdoll
Rat Terrier
Redbone Coonhound
Retriever
Rhodesian Ridgeback
Rottweiler
Russian Blue
Saint Bernard St. Bernard
Saluki
Samoyed
Schipperke
Schnauzer
Scottish Deerhound
Scottish Fold
Scottish Terrier Scottie
Sealyham Terrier
Selkirk Rex
Setter
Shar Pei
Sheep Dog
Shepherd
Shetland Sheepdog Sheltie
Shiba Inu
Shih Tzu
Siamese
Siberian
Siberian Husky
Silky Terrier
Singapura
Skye Terrier
Sloughi
Smooth Fox Terrier
Snowshoe
Somali
South Russian Ovcharka
Spaniel
Sphynx (hairless cat)
Spitz
Staffordshire Bull Terrier
Swedish Vallhund
Terrier
Thai Ridgeback
Tibetan Mastiff
Tibetan Spaniel
Tibetan Terrier
Tiger
Tonkinese
Tosa Inu
Toy Fox Terrier
Treeing Walker Coonhound
Turkish Angora
Turkish Van
Vizsla
Weimaraner
Welsh Corgi
Welsh Springer Spaniel
Welsh Terrier
West Highland White Terrier Westie
Wheaten Terrier
Whippet
White German Shepherd
Wire-haired Pointing Griffon
Wirehaired Terrier
Xoloitzcuintle/Mexican Hairless
Yellow Labrador Retriever
Yorkshire Terrier Yorkie
Third Breed of Dog you are interested in adopting
1.N/A
Abyssinian
Affenpinscher
Afghan Hound
Airedale Terrier
Akbash
Akita
Alaskan Malamute
American Bulldog
American Curl
American Eskimo Dog
American Shorthair
American Staffordshire Terrier
American Water Spaniel
American Wirehair
Anatolian Shepherd
Appenzell Mountain Dog
Applehead Siamese
Australian Cattle Dog/Blue Heeler
Australian Kelpie
Australian Shepherd
Australian Terrier
Balinese
Basenji
Basset Hound
Beagle
Bearded Collie
Beauceron
Bedlington Terrier
Belgian Shepherd Dog Sheepdog
Belgian Shepherd Laekenois
Belgian Shepherd Malinois
Belgian Shepherd Tervuren
Bengal
Bernese Mountain Dog
Bichon Frise
Birman
Black and Tan Coonhound
Black Labrador Retriever
Black Mouth Cur
Bloodhound
Bluetick Coonhound
Bobtail
Bombay
Border Collie
Border Terrier
Borzoi
Boston Terrier
Bouvier des Flanders
Boxer
Boykin Spaniel
Briard
British Shorthair
Brittany Spaniel
Brussels Griffon
Bullmastiff
Bull Terrier
Burmese
Burmilla
Cairn Terrier
Calico
Canaan Dog
Canadian Hairless
Cane Corso Mastiff
Carolina Dog
Catahoula Leopard Dog
Cattle Dog
Cavalier King Charles Spaniel
Chartreux
Chesapeake Bay Retriever
Chihuahua
Chinchilla
Chinese Crested Dog
Chinese Foo Dog
Chocolate Labrador Retriever
Chow Chow
Clumber Spaniel
Cockapoo
Cocker Spaniel
Collie
Coonhound
Corgi
Cornish Rex
Coton de Tulear
Crossbreed
Cymric
Dachshund
Dalmatian
Dandi Dinmont Terrier
Devon Rex
Doberman Pinscher
Dogo Argentino
Dogue de Bordeaux
Domestic Long Hair
Domestic Medium Hair
Domestic Short Hair
Dutch Shepherd
Egyptian Mau
English Bulldog
English Cocker Spaniel
English Coonhound
English Pointer
English Setter
English Shepherd
English Springer Spaniel
English Toy Spaniel
Entlebucher
Eskimo Dog
Exotic Shorthair
Extra-Toes Cat (Hemingway Polydactyl)
Field Spaniel
Fila Brasileiro
Finnish Lapphund
Finnish Spitz
Flat-coated Retriever
Foxhound
Fox Terrier
French Bulldog
German Pinscher
German Shepherd Dog
German Shorthaired Pointer
German Wirehaired Pointer
Glen of Imaal Terrier
Golden Retriever
Gordon Setter
Great Dane
Greater Swiss Mountain Dog
Great Pyrenees
Greyhound
Havana
Havanese
Himalayan
Hound
Hovawart
Husky
Ibizan Hound
Illyrian Sheepdog
Irish Setter
Irish Terrier
Irish Water Spaniel
Irish Wolfhound
Italian Greyhound
Italian Spinone
Jack Russell Terrier
Japanese Bobtail
Japanese Chin
Javanese
Jindo
Kai Dog
Karelian Bear Dog
Keeshond
Kerry Blue Terrier
Kishu
Komondor
Korat
Kuvasz
Kyi Leo
Labrador Retriever
Lakeland Terrier
Lancashire Heeler
Leonberger
Lhasa Apso
Lowchen
Maine Coon
Maltese
Manchester Terrier
Manx
Maremma Sheepdog
Mastiff
McNab
Miniature Pinscher
Mountain Cur
Mountain Dog
Munchkin
Munsterlander
Neapolitan Mastiff
Newfoundland Dog
New Guinea Singing Dog
No Preference
Norfolk Terrier
Norwegian Buhund
Norwegian Elkhound
Norwegian Forest Cat
Norwegian Lundehund
Norwich Terrier
Nova Scotia Duck-Tolling Retriever
Ocicat
Old English Sheepdog
Oriental Long Hair
Oriental Short Hair
Oriental Tabby
Otterhound
Papillon
Patterdale Terrier (Fell Terrier)
Pekingese
Persian
Peruvian Inca Orchid
Petit Basset Griffon Vendeen
Pharaoh Hound
Pit Bull Terrier
Pixie-Bob
Plott Hound
Pointer
Polish Lowland Sheepdog
Pomeranian
Poodle
Portugese Podengo
Portuguese Water Dog
Presa Canario
Pug
Puli
Pumi
Ragamuffin
Ragdoll
Rat Terrier
Redbone Coonhound
Retriever
Rhodesian Ridgeback
Rottweiler
Russian Blue
Saint Bernard St. Bernard
Saluki
Samoyed
Schipperke
Schnauzer
Scottish Deerhound
Scottish Fold
Scottish Terrier Scottie
Sealyham Terrier
Selkirk Rex
Setter
Shar Pei
Sheep Dog
Shepherd
Shetland Sheepdog Sheltie
Shiba Inu
Shih Tzu
Siamese
Siberian
Siberian Husky
Silky Terrier
Singapura
Skye Terrier
Sloughi
Smooth Fox Terrier
Snowshoe
Somali
South Russian Ovcharka
Spaniel
Sphynx (hairless cat)
Spitz
Staffordshire Bull Terrier
Swedish Vallhund
Terrier
Thai Ridgeback
Tibetan Mastiff
Tibetan Spaniel
Tibetan Terrier
Tiger
Tonkinese
Tosa Inu
Toy Fox Terrier
Treeing Walker Coonhound
Turkish Angora
Turkish Van
Vizsla
Weimaraner
Welsh Corgi
Welsh Springer Spaniel
Welsh Terrier
West Highland White Terrier Westie
Wheaten Terrier
Whippet
White German Shepherd
Wire-haired Pointing Griffon
Wirehaired Terrier
Xoloitzcuintle/Mexican Hairless
Yellow Labrador Retriever
Yorkshire Terrier Yorkie
Have you ever owned the breed of dog you are applying for? *
No Yes
Is there a specific age you are looking for? (Check all that apply) *
Puppy
Adult
Senior
Is there a specific size/weight you are looking for?(Check all that apply) *
<25 lbs
25-50 lbs
50-75 lbs
+75 lbs
What sort of temperament are you looking for? (Check all that apply) *
Good With Kids
Good with Cats
Good with Dogs
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 *
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip Code *
Email Address *
Cell Phone *
Ex. 123-456-7890
Home Phone
Ex. 123-456-7890
Preferred method of contact *
Select one
Cell
Home Phone
Email
All of the above
Have you been a CT resident for at least the last 5 years? *
No Yes
If no, please advise prior state/s you resided in:
Chose all that apply.
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Home Information
How long have you lived at this address? (Years) *
Years
<1
1-5
5-10
10+
Home Situation *
Please select one.
House
Condo
Apartment
Other
If Other Please Describe
Do you own your current place of residence? *
Select One
Own
Rent
Live with Parents
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? *
No Yes
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): *
0
1
2
3
4
5
6
7
8
9
10+
(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? *
No Yes
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?
No Yes
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
Is everyone in your home aware that you are adopting? *
Select one
Yes
No
This is a surprise
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? *
No Yes
Canine Experience and Information
Have you ever adopted a dog from a rescue before? *
No Yes
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? *
No Yes
How many pets do you have?
1
2
3
4
5
6
7
8
9
10
Name of Pet 1
Type of Animal(Dog,Cat,Bunny,etc)
Age of Pet 1
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Name of Pet 2
Type of Animal (Dog,Cat,Bunny,etc)
Age of Pet 2 (in years)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Name of Pet 3
Type of Animal (Dog,Cat,Bunny,etc)
Age of Pet 3 (Years)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Name of Pet 4
Type of Animal(Dog,Cat,Bunny,etc)
Age of Pet 4 (Years)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
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? *
No Yes
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? *
No Yes
How many vets do you currently use for your pets?
1
2
3
4
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? *
1
2
3
4
5
6
7
8
9
10
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?
1
2
3
4
5
6
7
8
9
10
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? *
No Yes
How many others pets live with you that don't belong to you?
1
2
3
4
Name of Other Pet 1
Type of Animal(Dog,Cat,Bunny,etc)
Age of Other Pet 1 (Years)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Name of Other Pet 2
Type of Animal (Dog,Cat,Bunny)
Age of Other Pet 2 (Years)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Name of Other Pet 3
Type of Animal(Dog,Cat,Bunny)
Age of Other Pet 3 (Years)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Name of Other Pet 4
Type of Animal(Dog,Cat,Bunny,etc)
Age of Other Pet 4 (Years)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
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?
No Yes
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.
First time dog owner
Had one or two
Had dogs growing up
Experienced dog owner
Experienced "special needs" dog owner
Where will your dog live? Select all that apply *
Select all that apply
Outdoor Only
Indoor/Outdoor
Indoor/Designated area of home
Indoor/Full run of home
Please provide details about when your dog will be outside. Please select all that apply *
Select all that apply
Deck
Leash Walked
Fenced Yard
Stationary tie out
Loose (no fence or tie)
Invisible fencing
Dog run
Dog house with chain/tie out
When will the dog be outside? (Select all that apply)
To use the Bathroom
Supervised to Play
Walks
Dog Parks
Unsupervised to Play
Will the dog ever by outside unsupervised? *
No Yes
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
Spay\Neuter (if not already completed)
Yearly vaccines
None
Do you plan on having your puppy/canine's ears clipped or tail docked? * *
Select one
Yes
No
Maybe
Why or why not? *
How do you plan on grooming your dog? (Select all that apply) *
Select all that apply
Professional grooming
Home haircuts
Everyday brushing
Weekly brushing
Only when necessary
Never
How often do you plan on taking your dog to the vet? Select all that apply *
Select all that apply
When they are sick/injured
Yearly exams and vaccines
Only if absolutely necessary
Never
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
I do NOT want a dog that needs additional training
Yes, but open to discussing
Not at all, I have experience with dogs
How do you plan on exercising your dog? *
Select all that apply
Minimal walks (less than 20 min a day)
Visits to dog park
Rigorous walks or jogs (45 min or more a day)
Free exercise in the yard
Hiking/Swimming
Leave tied out (unattended)
Do you have any interest in further training with your dog, *
Select all that apply
No
Obedience classes
Agility classes
Trick training
Search & rescue
Therapy dog
Frisbee/Fly ball
If advised during adoption
If advised by veterinarian
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
I do NOT want an un-housebroken dog
Crate training
Gating off to one room
Physical correction
I will return or rehome the dog
Consult a professional trainer
Under what circumstances would you decide NOT to keep a pet? Select all that apply *
Select all that apply
Moving
New Baby
Divorce
New Job
Illness/Allergies
Problems with pet's health or behavior
Expensive Vet bills
None
***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 *
Clear
Applicant Name *
Signature Date *