Dog Adoption Application Please enable JavaScript in your browser to complete this form.Name of animal you are interested in: *Name *FirstLastAddress *City *State *Zip *Home Phone *Work PhoneCell PhoneEmail *Employer *What is your current age? *When was the last time you owned a pet? *Why don't you own that pet currently? *Will this be your first dog? *YesNoPlease list the pets you have had in the past 5 years:Please include Name, Age, Breed, Sex, If Neutered, Still Have?, if No, Why?Pets Owned 2Please include Name, Age, Breed, Sex, If Neutered, Still Have?, if No, Why?Pets Owned 3Please include Name, Age, Breed, Sex, If Neutered, Still Have?, if No, Why?Pets Owned 4Please include Name, Age, Breed, Sex, If Neutered, Still Have?, if No, Why?Please provide your veterinarian’s name, address and phone number (if known): *Have they been spayed or neutered?YesNoI don't knowAre they current on vaccinations?YesNoI don't knowWill you keep this dog up to date on vaccinations?YesNoHave you ever turned your dog in to a shelter?YesNoIf 'Yes', please explain:Have you ever had a pet euthanized for medical reasons?YesNoIf 'Yes', please explain: (copy)If you have pets, will they adjust to a new dog entering the house?YesNoI don't knowWhy do you want this dog?CompanionCompanion for other petHuntingBreedingProtectionGiftOther - please explain:Where will the dog sleep? (Ex: basement, garage, kennel, dog bed, people bed, etc.)Does everyone living in your home know about and agree with your decision to adopt a dog?YesNoIf not, why?How many adults are in your household?What are the adults' ages and relationships to you?How many children?Please indicate ages of children.Does any member of your household have an allergy to dogs?YesNoIs someone home during the day?YesNoIf yes, who?How many hours each day will the dog be alone?Please provide details.Where do you live?HouseApartmentCondoMobile HomeOtherIf other, please explain:Do you own or rent your home?OwnRentIf you own, who is the owner on record?If you rent, may we contact the owner to obtain permission for this dog to live in your home?YesNoOwner's name and phone number:Do you have a completely fenced yard?YesNoIf fenced, please describe type of fence and height:Do you have a dog door? *YesNoHow will you housebreak your dog/puppy? *CrateFree RoamKeep outside until he/she learnsOtherAre you familiar with crate training? *YesNoWhere will you keep the dog? *In the houseOutdoorsFree access both indoors and outdoorsIn fenced runOtherIf other, please explain:Are there times when the dog will be tied up? *YesNoIf yes, when?Would you be willing and able to exercise the dog on a regular basis? *YesNoExercise Method:If you go away for a few days, or on a vacation, who will take care of the dog? *If you move, will you take the dog with you? *YesNoWhat behavior will you have the most difficulty dealing with? *What would you do if your dog exhibited bad behavior you didn't like? Such as: chewed on your valuable items, hard to fully potty train, jumping on people, mouthing humans, hurt another pet, bite someone. *Have you ever applied to Middletown Humane to adopt an animal? *YesNoIf yes, when?Do you have any experience training a dog/puppy? *YesNoDo you or have you ever used a professional dog trainer? If so, who? *Have you ever brought animals to Middletown Humane? *YesNoIf yes, please explain:Are you willing to have a representative of Middletown Humane come to see where the dog will be living? *YesNoIf no, please explain:Are you willing to take responsibility of this dog for the next 10 to 15 years? *YesNoWhat provisions will you make for the dog should you become unable to care for him/her? *How much are you willing to spend on medical bills for your dog? *Up to $100Up to $500Up to $1,000Up to $5,000Whatever it takesWhat would you do if the vet bills went over this amount? *Do we have your permission to view your social media accounts? *YesNoPlease provide two personal references (no relatives): *Phone *Ref #2 *Ref Phone #2 *Please read the following and check the box to complete the application. *I certify the above information is true. I understand that giving false information on the application is grounds for denial of application and repossessing the dog if the application is approved. I understand the Middletown Humane Society reserves the right to deny any application.Submit
