Zen Dog CT Dog Adoption Application

Dog Adoption Application

Name of dog you wish to adopt?*

Dog Name

How did you find out about ZEN DOG CT?*

ALL ABOUT YOU

Your Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

How long have you lived at this location listed above? *

Phone Number*

Area CodePhone Number

What type of phone number is listed above?*

Email Address*

Date of Birth*

Date

Are you on FaceBook?*

YesNo

If yes, what is your FaceBook name?

Name as listed on FaceBook

Employer*

YOUR HOUSEHOLD

Are all members of the household in agreement to adopt a dog?*

Who will be the dog's primary caregiver?

Name

What type of home do you have?*

Do you own or rent your home?*

OwnRentOther

If you rent, please provide your Landlord's Name & Phone Number. *

Landlord Name & Phone Number

Please list the full names of all the adults in the home.*

Example: Jane Smith, Joe Smith and Karen Winters

Please list the NAMES and AGES of all the children in the home.*

Example: John (3 years), Mary (10 years) & Carol (10 years)

If you have children, have they been around animals before? Please explain.*

Does anyone living in the home have allergies? Please explain. *

PERSONAL REFERENCES

Please list 3 personal references below. We ask that only 1 reference is a relative. Thank you.

Personal Reference #1*

First NameLast Name

Phone Number*

Area CodePhone Number

What type of phone is this?

Personal Reference #1 Email:

example@example.com

How do you know this person? *

Example: Friend, Neighbor, Relative, etc.

Personal Reference #2*

First NameLast Name

Phone Number*

Area CodePhone Number

What type of phone is this?

Personal Reference #2 Email:

example@example.com

How do you know this person? *

Example: Friend, Neighbor, Relative, etc.

Personal Reference #3*

First NameLast Name

Phone Number*

Area CodePhone Number

What type of phone is this?

Personal Reference #3 Email:

example@example.com

How do you know this person? *

Example: Friend, Neighbor, Relative, etc.

Pet History

We want to know more about you and your pet history and experience.

Please list ALL the animals you have had in the last 20 years. Indicate if you still have them or what happened to them. If they were spayed/neutered, their species and age. *

Example: King, dog/German Shepherd mix (Neutered, died at age 13)

Have you adopted from an animal rescue before?*

YesNo

If yes, which animal rescue?

Have you ever surrendered or rehomed a pet before? Please explain. *

VETERINARIAN INFORMATION

Below, please list the Veterinarian you have used (in the last 20 years) or currently use. If you do not have a Veterinarian, please list the one you WILL be using should you adopt a dog from Zen Dog CT.

Veterinarian's Name*

This Veterinarian is:*

CurrentPastPlan on using with this dogOther

Veterinarian's Phone*

Area CodePhone Number

LIFE WITH YOUR NEW DOG

We feel it's important to make a proper match when placing a dog. Not just people to dog, but dog to people, dog to the home enviroment and the family's schedule. All of these are factors in a smooth transition process and proper fit. It's important to answer these questions honestly.

Describe your ideal dog for your home. This will help us ensure a good match.*

Be sure to think of your daily schedule and lifestyle.

Are you familiar with crate training and how do you feel about using a crate in your home?*

How many hours a day will your dog be left home alone. Please explain.*

Where will your dog sleep at night? *

Where will your dog be allowed while you are not home?*

Do you plan on taking obedience classes with your dog?*

If your dog has an accident in the house, what type of corrective training do you plan to use?*

How long are you willing to allow for your new dog to adjust to your new home? *

Are you aware that a new environment for a dog can be stressful and they need time to adjust and decompress? They may display uncharacteristic behavior during this period of time.*

What circumstances would lead you to give up a pet? And what would you do if you faced this sort of decision?*

Do you understand that having a dog will cost $500.00 or more per year in basic routine vet care and preventatives?*

YesNoI would like more information on costs.Other

Please put any additional information here that you would like to convey to the Zen Dog CT Adoption Team:

Please read below to better understand our adoption process.

I understand the adoption process with Zen Dog CT includes: a completed application, a check of my personal and vet references, permission from landlord (if applicable), home ownership verification (if applicable), a phone or in person interview and a home visit (with all family members present).

I understand my responsibilities as an adopter includes: providing my new pet with vet care, including checkups, booster vaccines or titer test, flea/tick preventative medications, etc. I will be solely responsible for the health, safety and behavior of my new pet.

Once adopted I release and hold Zen Dog CT and it's volunteers harmless from responsiblity for any medical expenses incurred on behalf of this pet and for the behavior of this pet. If at anytime in the future I cannot care for this pet I will contact Zen Dog CT for re-homing and will under no circumstances bring this pet to a shelter or give away to another person.

I understand that meeting a rescue animal can carry a risk and I will not hold Zen Dog CT or it's volunteers liable for any harm that comes to me or my family during a meeting with the animal. I will follow all rescue directions on how to greet an animal.

By completing this form, I agree to all the terms listed within it.

Applicant's Signature*