NAUGATUCK DOG ADOPTION APPLICATION
Full Name
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First Name
Last Name
Phone Number:
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Please enter a valid phone number.
Format: (000) 000-0000.
Address
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Street Address
Apartment / Floor
City
State / Province
Postal / Zip Code
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Residence Type
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Please Select
House
Apartment
Condo
Mobile Home
Other
How Long have you lived at your current residence?
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Please Select
Less than 1 year.
1 to 3 years.
3 to 7 years.
7 years or more.
Is your residence pet-friendly?
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Yes
No
Is there a fully fenced yard?
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Yes
No
N/A
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Emergency & Contingency PlanningWho will care for the dog if you are ill or unavailable?
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Please list all adults and children living in the home: Name/Age/Relationship/None
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Do you currently have pet(s):
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Please Select
Yes
No
If yes, list species, breed, age, and spay/neuter status:
Veterinary Information Veterinarian or Clinic Name & Phone Number:
Adoption Preferences/Dog you are interested in (name or description):
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How many hours per day will the dog be alone?
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Please Select
Never
1-3
3-5
5-8
8-10
Where will the dog sleep at night?
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Who will be primarily responsible for the dog’s care?
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Do you plan to provide training?
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Yes
No
If yes, what type (basic, professional trainer, classes)?
Are you prepared for the financial responsibility of dog ownership (food, vet care, grooming, emergencies)?
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Yes
No
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Authorization & Waiver I authorize Naugatuck Animal Control to verify all information provided in this application. I understand and agree that this may include contacting references, veterinarians, landlords, and conducting a home visit if deemed necessary. I acknowledge that adoption approval is at the sole discretion of Naugatuck Animal Control and that submission of this application does not guarantee adoption. I agree to provide proper care, including food, water, shelter, veterinary care, training, and compliance with all local and state animal control laws and ordinances. I release and hold harmless the Town of Naugatuck, Naugatuck Animal Control, its officers, employees, agents, and volunteers from any and all claims, liabilities, damages, injuries, or causes of action arising out of or related to the adoption, ownership, behavior, or health of the adopted dog. I understand that any known history of the dog has been disclosed to the best of Naugatuck Animal Control’s knowledge, but no guarantees are made regarding temperament, behavior, or future health. I certify that the information provided is true and complete. I understand that providing false information may result in denial of this application. I agree to a home visit if required.
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