Application to Adopt A DOG

Submitting An Application:

For your convenience, an online application is available below. Or, you may print the PDF version of the application (located in the right-hand column) and return it by:

Faxing it to: (860) 216-5637
Scanning and emailing it as an attachment to: ADOPT@thesimonfoundation.org

A vet reference is required as part of the application process. To expedite this process, please call your vet in advance and give them permission to release your records to us.

Online Application to Adopt A DOG

* Required

Title

First Name *

Last Name *

Email Address *

Home Address *

City *

State *

Zipcode/Postcode *

Country *

Home Phone Number *

Work Phone Number *

Cell Phone Number *

Enter Word Verification in box below *

Name of the dog you would like to adopt: *

What is your occupation? *

Spouse/Partner's occupation?

Do you live with: *

What are your current living arrangements? *

How long have you lived at this address? *

How long do you plan to live at this address? *

Do you rent or own? *

If you rent, does your lease allow pets? *

If you rent, please provide contact information for your landlord:

In what type of setting is your home located? *

Name and phone number for veterinarian you will use with this pet: *

Does your municipality have breed specific restrictions? *

If YES, please describe restrictions:

Do you currently own any other pets or are there any other pets living in your home? *

If YES, please list the name, animal type, breed, age, gender, spay and neutor status and declaw status of each animal:

If YES, how were these pets acquired?

If YES, list the name and phone number of the veterinarian you currently use for these pets:

If YES, whose name is listed on the veterinary records?

Other than your current pets, have you owned any other animals? *

If YES, please list the breed, gender, spay or neuter status, weight, number of years owned and cause of death for each pet: *

Do you have a yard? *

If YES, is it chemically treated? *

If YES, how big is it?

Is the yard completely fenced in? *

What type of fencing do you have?

Do you have a pulley cable? *

Approximate length of pulley cable?

Do you have a kennel run? *

Approximate dimensions?

If you do NOT have a fenced yard, cable or kennel run, how will excercise/toilet be handled?

How many adults live in your home? *

Ages of adults:

How many children live in your home? *

Ages of children:

Does anyone in your house have allergies to animals? *

Does anyone in your house have asthma? *

What is the noise/activity level in your household? *

Who will be responsible for the care and training of the dog? *

What is your experience with dogs? *

If you have children, please describe their experience with dogs:

Do children visit your home often? *

If YES, what are their ages?

Is anyone home during the day? *

If YES, who?

If NO, how many hours a day will the dog be left home alone?

Where will the dog be kept during the day? *

Where will the dog be kept at night? *

Where will the dog sleep? *

Will you crate the dog? *

If NO, please explain:

Have you ever experienced behavior or training problems with a dog? *

If YES, please explain the issues and how they were resolved:

Do you plan to train your dog? *

If NO, why not?

What will you do if your dog is destructive? *

What is your definition of disciplining a dog? (please provide examples) *

Have you ever surrendered a pet? *

If YES, please explain the circumstances:

If for any reason you cannot keep a Simon Foundation adopted pet, do you agree to return it to The Simon Foundation, Inc.? *
Yes
No

Would you be willing to have an initial in-home visit or follow-up visit by a representative of The Simon Foundation, Inc. if The Simon Foundation, Inc. deems it necessary? *

Are you willing and able to accept full and immediate responsibility for the ownership of a dog, including all health care costs and necessary burdens and responsibilities of owning a pet? *

Are you willing to seek and begin immediate training if some behavioral issues arise within days of taking ownership of the dog? *

If NO, why not?

How did you hear about The Simon Foundation, Inc.?

Please list two (2) references who are not family members: (include name, phone number, relationship) *

Please provide a veterinary reference: (include name, phone number, address) *

Download & Print:

Application to Adopt a DOG (1076 KB)

Adopting a Puppy:

We will not schedule a meeting with a puppy until your Application to Adopt has been received.
SORRY NO EXCEPTIONS!