Haven Interested Party Application Dog

Animal you are interested in adopting	Mia (Cat - C2022035) Rainier (Cat - C2023008) Rocky (Dog - D2023002) Sweetie (Dog - D2022006) Zelda (Dog - D2022004)
Applicant's First Name
Applicant's Last Name
Street Address
City
State
Apartment Number (if applicable)
Zip Code
Phone Number
Email Address
Date of Birth
Please tell us a bit about yourself and what you are looking for in a doggie match up.
Please list contact information for three personal references that are not related to you. Failure to provide this information upfront will invalidate the application.
Do you have other pets at the current time?	NoYes
If yes, please list their names, breeds, and ages.
Are all of your pets spayed/neutered/fixed?	Yes No N/A
Are your pets current on their vaccinations?	Yes no n/a
What other pets have you had in the last 15 years? What happened to them?
If you no longer have them, what happened to them?
Have you ever turned your dog or cat into a shelter?	NoYes
If yes, please explain?
Did any of your pets every have behavioral issues?	NoYes
If yes, what were the issues and how did you address them?
Veterinarian's Name
Veterinarian's Address, City, State, and Zip Code
Veterinarian's Phone Number
What is the main reason you plan to adopt a pet?
What energy level are you looking for in a dog?
Please select what is necessary to you in a dog that you would adopt ( select all that apply).	Housetrained Can be left unattended in the home Rarely barks Doesn't chew Will run/jog with me Good with strangers Good with livestock Already knows basic obedience Can be walked off leash Doesn't dig Likes to fetch/play Gentle with young children Likes other dogs Good with cats Doesn't pull on leash Doesn't jump up Low-shedding Doesn't wander Good watchdog Good in car Other
Do you own or rent your home?	Own Rent Someone else owns the Home Someone else rents the Home
Please select your current residence type.	House Apartment Condo Townhouse Mobile Home Other
If you answered "other" above, please explain here:
How long have you lived at this address?
If you rent, does your landlord and lease allow pets?	Yes No Unsure N/A
Landlord name and contact information
Including yourself, how many people live in your household?
Please list the names, ages and relationship of those who live in your home.
Does anyone in your household have allergies to dogs/cats?	Yes No Possibly N/A
Employment Status	Full-Time Part-Time Retired Work from Home Stay at Home Parent Student Unemployed Other
If you chose "other" above, please explain:
If you are employed, what is your current occupation and how long have you worked there? If there is a partner or spouse, what is their employment information?
On average, how many hours per day will your pet be left alone?
How much do you think the annual medical bills will be for your pet?	About $100 $100 - $200 $200 - $300 $300 - $500 $500 +
What would you do if the bills went over this amount?
Do you have a completely fenced-in yard? If so, what kind of fence?	Wood Chain Link Electric Plastic Iron Other Other (I do not have a fenced yard)
What is the height of the fencing?
If you answered "other" above, please explain:
If you do not have a fenced yard, how will you let the animal out?
Are there times when the animal will be tied/chained up?	Yes No N/A
If yes, when will they be tied/chained up?
Where will the animal sleep?	In bed with me In bed with my child In a dog / cat bed In a kennel / crate Wherever he or she likes Outside Other
If you answered "other" above, please explain:
How will you handle housebreaking?
How will you handle destructive behavior?
How will you handle behavioral issues?
Are you willing and able to exercise the dog on a regular basis?	Yes No N/A
If yes, what is the method of exercise?	Walking Running Dog Park / Dog Run Other
If you answered "other" above, please explain:
What will you do with the animal when you go on vacation?	Leave with family/friend Boarding Pet sitter Take with me/us Other
If you answered "other" above, please explain:
For what reason(s) would you consider returning/giving up the animal?
What would you do with your animal if you had to move?	Take him / her with me Give to family or friend Return to shelter Other
If you answered "other" above, please explain:
Will you allow us to perform a home check?	NoYes
Are there specific questions you have for us?
I have read the foregoing and certify that the answers I have given are complete, true and not misleading in any way. I am authorizing you to contact landlords, associations and veterinarians. You are also aware that we cannot guarantee the health and temperament of the animal.	Yes No