Pet Adoption Application Form

Naugatuck Animal Control

Adoption Application, Contract and Waiver

Name or IMPOUND NUMBER of Pet You Wish to Adopt*

Impound Number or Animal Name

Name or IMPOUND NUMBER of Pet You Wish to Adopt (IF APPLYING FOR MORE THAN ONE)

Impound Number or Animal Name

YOUR Email Address*

Perspective Pet Parent*

First NameLast Name

Date of Birth of Perspective Pet Parent #1*

Date

Phone Number*

Area CodePhone Number

Other ADULT Living in household

First NameLast Name

Date of Birth of Other Adult Living in Household

Date

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Your place of employment

Do you own any pets?*

Why would you like to adopt this particular dog(s)?*

YOUR CURRENT Pet(s) Name(s)

Pet Breed(s)

Is your current pet vaccinated for Rabies? Is your Dog Licensed with your town?*

No, my pet is NOT vaccinatedYes, all my pets are vaccinatedNo, my dog is younger than 6 months oldMy pet(s) / Cat(s)/Dog(s) are all vaccinatedMy dog(s) ARE LICENSED in my townMy dog(s) ARE NOT LICENSEDNA - I do not currently own any animals.

Pet's disposition and behavior towards other dogs/cats?

Please provide your veterinarian's name and phone number - IF YOU DON'T have one, PROVIDE THE VETERINARIAN YOU INTEND TO USE:*

Do you own or rent your home?*

OwnRent

Do you have a yard?*

YesNo

If "Yes" to the above, is it fenced? please describe

What is your landlord's pet policy?*

If you rent, please provide your landlord's information here:*

Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter?*

YesNo

Are there children in the home? (If yes, please list ages)*

If you answered "Yes" to the above question, please provide detail:

How many hours per day would the pet be alone?*

Will you crate your pet?*

If you have to leave town, emergently or planned, where would your pet stay?*

How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?*

Please provide the names, emails, and contact numbers for 3 personal references:*

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?*

YesNo

If you answered "Yes" please provide a detailed description:

By clicking the submit button, I agree to the Naugatuck Animal Control adoption process, will undergo a homecheck, and interview at the discretion of Naugatuck Animal Control.
By clicking the submit button, I understand Naugatuck Animal Control will check my references including veterinary and personal.
By clicking the submit button, I understand there is an adoption fee associated with adoption of a pet from Naugatuck Animal Control.
By clicking the submit button, I understand there is no "cooling off" period, and that if I no longer want or can no longer care for my adopted pet, I agree to notify Naugatuck Animal Control BY EMAIL and provide them the prospective steps you are taking to place the animal.
By clicking the submit button, I agree to indemnify and hold harmless Naugatuck Animal Control and the Borough of Naugatuck against any losses, lawsuits, claims, injury, damages incurred by me or to any persons or property by my adopted pet, once adoption has been completed.
By clicking the submit button, I understand that Naugatuck Animal Control will disclose any of the pet's health or behavior issues known, before adoption is completed.
By clicking the submit button, You understand that Naugatuck Animal Control has the right to deny your application without notification or explanation. Per state statute #22-332, the Animal Control Officer has the authority to adopt an animal under his or her own discretion.
Filling out this application does NOT automatically approve you for the animal or put a “hold” on an animal.
By clicking the submit button, I understand and will follow State of Connecticut Animal Laws and will comply with them to the best of my ability.
By clicking the submit button, I verify all of the above information is true and accurate.

Signature - all info is true and correct

Date YOU Submitted to Naugatuck Animal Control

Date