Wallingford Animal Shelter 5 Pent Rd, Wallingford, CT 06492 Phone: (203) 294-2180 Fax: (203) 294-2181 You must submit an application prior to meeting a dog, as we are often inundated with interest in some of our dogs and it is a more efficient use of all of our time to pre-screen applicants. Each adoption application is reviewed for suitability prior to placement. Submitting an application does not guarantee you will receive a rescued animal. We reserve the right to deny anyone the adoption of an animal without explanation. All placements are at the discretion of the Animal Control Officer. Applicants must be 18 years of age or older. Any application that is incomplete or contains false information will not be considered. Upon adoption of a dog, you must sign an agreement that releases the Town of Wallingford of all liability for that dog. Because of our time-consuming animal control responsibilities, please allow 5-10 business days for us to process your application. If your application has not been approved, you may not receive a response, as we do not have the time to respond to everyone who applies to adopt our animals. Thank you. ADOPTION APPLICATION - DOG Name: Street: City: Home Phone: Work Phone: Cell Phone: Age: State: Zip: Hours: ANIMAL YOU ARE APPLYING FOR: --------------------------------------------------------------------------------------------------------------------- 1. What kind of residence do you live in? A) Apartment B) Condo C) Multi-family home D) Single family home E) Other-explain --------------------------------------------------------------------------------------------------------------------- 2. If you do not own your home, please provide the name and phone number of your landlord. Name: Phone: --------------------------------------------------------------------------------------------------------------------- 3. How many people live in your home? State their name, age and their relationship to you. --------------------------------------------------------------------------------------------------------------------- 4. Do you have children? If so, please list names, ages, activity level, pet experience, etc. ---------------------------------------------------------------------------------------------------------------------- 5. Do you have any pets now? If so, please give details such as name, breed, age, sex, and whether or not they are spayed/neutered. If pet is not spayed/neutered, please explain why: -------------------------------------------------------------------------------------------------------------------- Page 2 6. What is the activity level in your home? A) Busy - visits from friends, meetings, children, parties at home B) Noisy - television, stereo, machinery, tools, kids playing C) Moderate - normal comings and goings D) Quiet - homebodies, few guests, no children --------------------------------------------------------------------------------------------------------------------- 7. Please tell us about previous pets (name, breed, age, sex, spayed/neutered) and what happened to them. If your pet is deceased, please indicate why and approximate year pet passed away. --------------------------------------------------------------------------------------------------------------------- 8. Who would have primary responsibility for the care of this dog? --------------------------------------------------------------------------------------------------------------------- 9. Would the dog be alone during the day? If so, for how long and where in the house will the dog stay? --------------------------------------------------------------------------------------------------------------------- 10. Please describe your work schedule. --------------------------------------------------------------------------------------------------------------------- 11. Do you have a fenced in yard or completely fenced area? If yes, please describe in detail including approximate size of fenced area, height and type of fence: --------------------------------------------------------------------------------------------------------------------- 12. Why do you want to adopt a dog at this time? Why this particular dog? --------------------------------------------------------------------------------------------------------------------- 13. What qualities are you looking for in a dog? --------------------------------------------------------------------------------------------------------------------- 14. What other facilities and opportunities do you have for exercising a playful, active dog? --------------------------------------------------------------------------------------------------------------------- 15. Please explain the training methods have you used for previous or current dogs? --------------------------------------------------------------------------------------------------------------------- Page 3 16. Would you be willing to take this dog to obedience classes? --------------------------------------------------------------------------------------------------------------------- 17. Please describe where the dog will be kept: A) At night? B) During the day? C) When you are not home? D) When you are on vacation? --------------------------------------------------------------------------------------------------------------------- 18. If you currently have another dog, will you separate them when you are not home? If so, how will you do this? (crates, baby gates, closed off in different rooms, etc) --------------------------------------------------------------------------------------------------------------------- 19. Under what circumstances might you decide NOT to keep a pet? A) New job B) Moving C) New baby D) Marriage or divorce E) Illness or allergies F) Problems with pet's health G) Problems with pet's behavior H) Other - please explain: ------------------------------------------------------------------------------------------------------------------- 20. Have you ever been in a situation where you were not able to keep a pet? If so, please explain. What did you do with the pet? -------------------------------------------------------------------------------------------------------------------- 21. Have you ever owned the breed of dog you are applying for? --------------------------------------------------------------------------------------------------------------------- 22. Have you ever had experience with an emotionally or physically neglected or abused dog? If so, how did you acquire the dog? What methods did you use to resolve any issues? Were the problems resolved? --------------------------------------------------------------------------------------------------------------------- Page 4 23. Are you aware that a rescued dog may not be fully housetrained at the time of placement? ---------------------------------------------------------------------------------------------------------------------24. Are you willing and able to housetrain a puppy or adult dog? What methods will you use to housetrain this dog? --------------------------------------------------------------------------------------------------------------------- 25. Are you in a position to assume the financial commitment that a dog requires, including unexpected illness and medical emergencies? The average cost for basic dog care per year is $1,000. Can you afford the financial commitment of unexpected emergencies? --------------------------------------------------------------------------------------------------------------------- 26. What is the name of your employer? What is your position? --------------------------------------------------------------------------------------------------------------------- 27. How long have you been with the above stated employer? --------------------------------------------------------------------------------------------------------------------- 28. May we call your employer for a character reference? If yes, please provide a name and phone number. --------------------------------------------------------------------------------------------------------------------- 29. Please give the name and phone number of your veterinarian. If you have more than one vet, please specify the names of the animals that go to each. If you have switched vets recently, please list both and indicate how long you have used your current vet. If your pets are vaccinated at a clinic such as Petco, please so indicate with a phone number. Please let your veterinarian or clinic know that we may be calling for a reference and give them permission to speak with us. ---------------------------------------------------------------------------------------------------------------------- 30. Please list two personal references and state their relationship to you (no family members please.) A) Name: Phone: Relationship: B) Name: Phone: Relationship: I, ________________, acknowledge that I have read and understand this Adoption Application in its entirety and I declare that all the information submitted herein is true and accurate. Date: _________________ ______________________________________ Applicant: