Your Contact Information

Any Application not completed IN FULL will not be processed.

Information About Your Household Members

Please list the people that currently live at your residence or visit frequently.
(Please list relationship to you & their age.  We don't need the children's names.)

Does anyone in the household have any known allergies to animals?Yes No  If yes, please explain.
 

Does anyone in the household have asthma?  Yes No 

Information About Your Home

Which of the following best describes your current residence? (Check one)
Home  Townhouse  Apartment  Condominium  Duplex  Mobil Home  Other 

Do you own or rent? Own Rent

If you do NOT rent your home, are you the owner of the home? Who owns the residence?

Do you have a fenced yard?  No  Yes  Type of Fencing
Fence Height    Type of Gates
Is fence solid & secure?  No  Yes    Can children open gates?  No  Yes
Comments on Fencing

Information About Your Pets

Please list all current pets.  Include all animals residing with you, even if you do not own them.
If you do not currently live with any pets, please describe pets owned in the past.
List your pets by name, their species, and breed.

Are all the above animals current on vaccinations & heartworm preventative? Yes  No

Are they all spayed and/or neutered?  Yes No

If you answered no above, please explain why they have not been altered.

What happened to any previous pets that you no longer own?

Have you ever had to give up a pet?  (For example had to give away or take to a shelter.)
Please explain why & when.

Vet References

If you do not have a current vet, who is the vet you intend to see?

Personal References

Please provide us with a personal reference, not related to you.
(Name, address and phone number and relationship to you)
 

Animal You Are Interested In Adopting

Please list the name(s) of the animal or animals you wish to adopt (include breeds and ages if known).

Please remember that we cannot guarantee or hold animals for you. The pet you name may have been adopted by the time your application is approved, or may already be scheduled to meet his/her new family. 

If the animal you are interested in has already been adopted, or in the process of being adopted, do you wish to continue the application process to be pre-approved for another pet in or program, or one that may be joining later? We recommend continuing with the application process towards pre-approved status.  Yes No

Even if you are applying for a specific animal, please tell us what kind of pet you want to adopt... your preferences with regard to breed, size, gender, age, color etc. Or name specific pets by order of interest.

How soon are you hoping to adopt?

Please provide SPECIFIC information for the following questions about where your potential new pet will spend time. The more detail the better.  Tell us WHERE. If outside, where outside? If inside, where inside? Please help us understand exactly what sort of life we can expect for this animal. 

Where will the pet be kept while you are at work or out on errands? Please provide detail.

Who will care your your pet while you are on vacation?

Do you have a crate? If so, how is it used, how often is it used, and under what circumstances?

Approximately how many hours a day will your new pet be alone?

Are you willing and able to support a pet for the remainder of their life?  Yes No

Are you willing to enroll the dog in obedience classes if deemed necessary?  Yes No

Do you understand that the dog should NEVER be allowed off lead in open spaces?  Yes No

How did you find out about Canine Connections Rescue?  Or who referred you? (Please be as specific as possible - Vet, Shelter, Friend, Newspaper, Internet, Other)

We require a home visit as part of the application process. Do you agree to a rescue representative visiting your home prior to & after adoption? Yes No

Any other comments you'd like for us to consider when reviewing your application to adopt:

Your email address.  (Sorry I know we already asked but we need it again.)

Clicking the Submit Button will return you to our website.

Thank you so very much for applying to adopt through Canine Connections. If your have any comments or concerns about this program please take a moment to share them with us via email. We are always interested and open to your viewpoint.

Of course, our rescue organization is always grateful to accept donations, which will help us to continue to provide care to homeless animals until suitable forever homes can be found.  Also please let us know if you would like to volunteer!  We need you and the animals need you.

Jackie & Mike Abrams
Canine Connections
Email: jabrams@windstream.net