Bridgeport Animal Control Facilities Adoption Application
Impound #’s interested in:

1st choice ______2nd choice______3rd choice______

Personal Information

1. Applicant Name: / 1a.Date of Birth: / 13. Others in Household:

(Please Include Ages)

/ Adults: / Children:
2. Co-Applicant Name (spouse, partner, etc.): / 2a.Date of Birth:
3. Street Address: / 14. Type of Housing:
(Please read policies below) /  Own  Rent  Live w/ Parents
 Other:
4. City: / 5. State: /
6. Zip:
7. Time at this Address (years, months, etc.): / Housing Policies:
  • Renters: Must bring a NOTARIZED LETTER from their landlord stating they are allowed to have pets or a copy of their lease stating they can have pets.
  • Owners: Must bring proof of ownership on their home (i.e. tax bill or mortgage statement).
  • Live w/ Parents: Must bring your parents tax bill or mortgage statement if they own, or the NOTARIZED LETTER from their landlord if they rent.

8. Home Phone:
9. Work Phone:
10. Mobile Phone:
11. Email:
12. Best time and place to contact: /

15. Are you employed?

 Yes  No  Retired /

16.Is your co-applicant employed?

 Yes  No  Retired

Adoption Information

17. If adopting a DOG, what is your experience level?
 First-time owner  Have had 1 or 2  Experienced / 18. If adopting a CAT, what is your experience level?
 First-time owner  Have had 1 or 2  Experienced
19. Do you plan to spay/neuter (alter)? /
19a. If NOT, why?
20. Can you afford to put at least $500 to $600 per year towards your new pets needs? / 21.How many hours each day will your pet be left alone?
 0-3  4-6  7-8  9 or more
22. Where will your new pet be kept?
 Inside  Outside  Both / 23. Do you have a fenced in yard?
 Yes  No  Partial / 24.Rate your roads traffic.
Not busy ( 1  2  3  4  5) Very busy
25.Why are you interested in adopting a new pet?
 Companionship for you/your family  Companionship for your current animal  Gift  Guard Dog  Other:
26.Rate your household activity.
Not busy ( 1  2  3  4  5) Very busy / 27.Have any of your animals been lost or stolen? / 27a.If YES, explain:
28.Have you adopted from us before? / 28a.Do you still have this animal? / 28b.If NOT, explain:
29. What animals do you currently own? / 30.What type of animals have you owned in the past?
31. Reference One: / 31a. Reference Two:
Name: / Phone #: / Relation: / Name: / Phone #: / Relation:
32. Name of current veterinarian: / OR / 32a. Name of veterinarian you plan to use:
PLEASE READ AND SIGN
  • This form is to ensure that the animal and the potential adopter’s are compatible. Incomplete forms or false information may result in rejection of this request.
  • Per state statute the Animal Control Officer has the authority to adopt an animal under his or her own discretion (State Statute #22-332).
  • Filling out this adoption application does not automatically approve you for the animal or put a “hold” on an animal.
  • I authorize investigation of all information and statements on this form, and understand that misrepresentation or omission of facts called for is cause for denial of an adoption.
  • I further state that I understand the above statements and certify that all the information in this application is true and correct to the best of my knowledge.

Signed: Date: Time:

(203) 576-7727 Phone 525 Asylum Street, Bridgeport, CT 06610 (203) 576-8119 Fax

BACF on the Web: bas.petfinder.com