Adoption Application

Adoption Application

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information

Adoption Application
This application is designed to help CT Animal House and yourself determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. CT Animal House reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions. Please keep in mind our Adoption Coordinator will be in touch with you 3-5 business days from the submission of your application. Thank you!
Applicant Information
Name of the pet you are interested in adopting:*
Enter-General Application in box-if you do not have a specific dog in mind
What about yourself makes you a good fit for the dog of you’re choosing?
Breed/Age:
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone:*

Area CodePhone Number
Work Phone:*

Area CodePhone Number
Cell Phone:*

Area CodePhone Number
E-mail:*
Place of Employment:*
If unemployed - enter “retired, student or N/A etc.”
Occupation:*
Address of Employer:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Describe your work schedule:*
Name of Spouse/Partner

N/AOther
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone:*

Area CodePhone Number
Work Phone:*

Area CodePhone Number
Cell Phone:*

Area CodePhone Number
E-mail:*
Spouse/Partner's place of Employment:*
Occupation:*
Address of Employer:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Household Information
Please describe your home. (I.e. studio, home, apartment, 2 bedroom, townhouse, farm, etc. *
Do you own or rent?*

OwnRentSubletCo-Op
If rent, please provide name and phone number of landlord or housing management:*

I do not rentOther
Have you lived at this address for at least 2 years?*

YesNo
If less than 2 years please provide previous address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does your landlord/ housing allow dogs?*

YesNoN/A I own
Are there any restrictions from your landlord or housing?*

Number of petsSize or weight restrictionsBreed restrictionsNoneN/A I own
Do you have a fully fenced yard?*

YesNo
Height and type of fence*
Do you have any of the following?*

Underground fenceKennelDog RunNone of the above
If you do NOT have a fence, will one be provided? If one cannot be provided, how will you exercise your new pet?*
Do you have children?*

Yes under 2 years oldYes 2-6 years oldYes 8 years +N/A
Have your children been around animals before?*

YesNoN/A

Please list the names, relationships of all adults living in the home:

Rows	Name	Age	Relationship to adopter	Pet allergies or asthma?
Person 1
Person 2
Person 3
Person 4
Person 5

Are all members of your household in agreement with this adoption?*

YesNo
Who will be the pet's primary caregiver?*
Current/Previous Pet Information

List any pets you own or have owned in the past ten years, and their ages, breed, temperament:*

Have you adopted from an animal rescue before?*

YesNo
If yes, please provide the rescue's name and contact information:*
Have you ever given up a pet?*

YesNo
If yes, what were the circumstances?*
Please provide the name and phone number of your current and/or previous veterinarian or clinic:*
New Pet Information
What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)*
Are you aware of crate training?*

YesNo
Have you ever house-broken a dog or puppy before?*

YesNo
If the dog has an "accident" in your home, what type of correction do you plan to use?*
How many hours each day will your new pet be home alone?*
Where will your new pet sleep at night?*
How will you supervise the dog's outdoor activity?*
Where will your new dog stay when nobody is home?*
What length of time will you allow your new pet to adjust to his new home?*
Are you willing to work through your new pet's issues, if any?*

YesNo
Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior?*

YesNo
Do you understand that a dog can be an 18 year commitment, and can cost hundreds of dollars per year to care for?*

YesNo
Do you plan to take an obedience class with your dog?*

YesNoNot sure
If yes, where?
Do you plan to use any of the following on your new pet:*

Prong collarMartingale collarRemote training collarNone of the above
What circumstances would lead you to give up your new dog?*
If you had to give up your dog, what would you do with him/her?*

Please list two non-family references that we may contact:*

Rows	First & Last Name	Relationship to you	Phone Number
Reference #1
Reference #2

How did you find out about CT Animal House*

Adoptapet.comPetfinder.comFacebookFriend/Family MemberOther
I certify that the above information is accurate, and that I have willingly provided it to CT Animal House. I will notify CT Animal House of any changes related to this information.

ATTENTION: Completion of this agreement does NOT guarantee that you will be approved for the adoption of this pet. CT Animal House is dedicated to placing our animals in the best homes possible. Therefore, we may decide to take more than one application on any of our animals. CT Animal House will contact the references that you have provided to ensure that we make the best decision for both the potential adopting individual/family and the pet. We appreciate your patience while we make our decision. After all this decision will be one that will last for the lifetime of your pet!
Signature:
Print Name:*
Should be Empty:

Pet Type;
Dog, Cat etc,

Temperament

Spayed/Neutered? If not, why?

Is this pet still with you? If not, why?