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CCA Adoption Application
Applicant Name
*
Phone #
*
Cell # or Secondary #
Address
*
Do you
*
Own
Rent
Email Address
How long have you lived in your current residence?
Are there any plans to move in the near future?
Yes
No
Landlord/Condo Board Contact name:
Landlord/Condo Board Contact phone number:
Number of adults in household
Have all adults in household agreed on adopting?
*
Yes
No
Still deciding
Number of children in household / ages
Other Pets in the household
Have all applicable pets in household been spayed or neutered?
Yes
No
No, Scheduled to do so
Veterinarian's Name
Vet's #
Have you had any pets as a family before?
Yes
No
What were those pets? (if applicable)
Is anyone in the household allergic to pet dander?
*
Yes
Yes, and currently medicated to tolerate pets
No
Not sure
Are you committed to providing a responsible home for your pet’s entire life?
Yes
No
Still Deciding
What is the purpose of adopting a pet from CCA?
Tell us a bit about why you are choosing to adopt from our organization.
How much time are you prepared to allow your new pet to adjust to your home?
Are you able to afford an unexpected emergency vet bill of $200-$800?
Yes
No
Would seek help from extended family members
If you have to move, what do you plan to do with your pet(s)?
Who in the household will be the animal’s primary care giver?
When you are out of town, who will be the animal’s care giver?
Where will the dog or cat be kept during the day?
Where will the dog or cat be kept during the night?
How many hours will your pet be left alone?
How many hours will your pet be left outside?
If you have behavior issues with your pet, are you willing to seek out training?
Yes
No
Applicant Signature:
*
By signing above, I certify that the information I have given is true to the best of my knowledge and belief. I understand that the CT Coalition for Animals has the right to deny my application for any reason. I further authorize the investigation of all statements in this application.
Date
