Dog Adoption Application

Animal(s) you are interested in adopting (you must be at least 21 years old to adopt) *
Applicant's First Name *
Middle Initial *
Applicant's Last Name *
Street Address *
City *
State *
Apartment Number (if applicable)
Zip Code *
Phone Number * Please use the following format 248-555-1212
Email Address * Please enter correctly as this is the main way we will contact you
Alternate Phone Number
Date of Birth *
Drivers License Number
How did you find out about us? *
Have you applied anywhere else for a pet? *
If yes, where else and when have you applied for a pet? *
Is this pet for you or someone else? *
Do you have other pets at the current time? *
If yes, please list their names, breeds, and ages. *
Are all of your pets spayed/neutered/fixed? *
How many pets have you had in the last 15 years? *
List the names, breeds and ages of each of those pets
What happened to each of them? (If deceased, how did the pet die?) *
Are your pets current on their vaccinations? * rabies and distemper
Have you ever rehomed or surrendered your dog or cat to a shelter? *
If yes, please explain? *
Provide the names of each of the veterinarians to whom you have brought your pets during the last 15 years. * If you have never owned a pet please tell us where you would go.
Provide the addresses of each of the veterinarians to whom you have brought your pets. * Again if you have never owned a pet please list where you would go
Provide the telephone numbers of each of the veterinarians to whom you have brought your pets. *
Have you contacted each of your present and past veterinarians to authorize release to The Animal Haven of information regarding your current and past pets? * Without these authorizations, we are unable to process your application.
Have you ever had a pet euthanized? *
If yes, please explain: *
How do you feel about having pets spayed/neutered? *
If you have pets, will they adjust to a new pet in the house? *
Please check the main reason you plan to adopt a pet: *
If you answered "other" above, please explain here: *
Please describe in detail the pet you are looking for. *
Do you own or rent your home? *
Please select your current residence type. *
If you rent, does your landlord and lease allow pets? *
If you answered "other" above, please explain here: *
If you own a condo or rent, please upload your lease/by laws stating that pets are permitted.
How long have you lived at this address? *
Including yourself, how many people live in your household? *
Please list the ages and relationship of those who live in your home. *
Do you have a completely fenced-in yard? If so, what kind of fence? *
If you do not have a fenced yard, how will you let the animal out? *
Does everyone in your household agree to adopt a pet? *
Do any of the residents in your home have allergies to any type of animal? *
If yes, who has allergies and what type of allergies does he/she have? *
What would you do if a family member became allergic to the dog? *
Employment Status *
If you chose "other" above, please explain: *
If you are employed, what is your current occupation? *
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? *
What would you do if the bills went over this amount? *
Would you get insurance for your pet? *
Are you familiar with heartworm and heartworm prevention? *
Will you keep the animal up-to-date on vaccinations and heartworm preventative? * That means going to the vet yearly and giving prevention monthly
If no, please explain: *
Please provide a description of this pet's living conditions. *
Will this dog be predominantly living inside, outside, or both? *
Are there times when the dog will be tied/chained up? *
If yes, please explain when and how they will they be tied/chained up? *
Have you ever been convicted of abuse or neglect of a child or animal? *
If yes, please explain: *
Where will the animal sleep? *
If you answered "other" above, please explain: *
Are you willing and able to exercise the dog on a regular basis? *
If yes, what is the method of exercise? Please check all that apply. *	Fenced yard Tie-out Leash walking Invisible fence Roam/Run free Other
If you answered "other" above, please explain: *
How will you handle potty training, if applicable? *
What behaviors are you not willing to work on? (e.g., house-training, chewing, barking, digging) *
Would you be willing to take your new dog to obedience training or a behaviorist if needed? *
What would you do with your animal if you had to move? *
If you answered "other" above, please explain: *
What will you do with the animal when you go on vacation? *
If you answered "other" above, please explain: *
What arrangements will you make for the care of your pets in case of an emergency? *
If you answered "other" above, please explain: *
In whose care do you intend to leave the dog if you become permanently unable to care for the dog? * Please provide NAME, PHONE NUMBER, and RELATIONSHIP to you. This is a MANDATORY step in the application process.
Are you willing to take responsibility for this animal for the next 10-20 years? *
Will you allow us to perform a home check? Please note, this is a mandatory step in our adoption process. *
For what reason(s) would you consider returning/giving up the animal? * e.g. new baby, shedding, nipping/biting, scratching, scratching furniture, allergies, divorce, pet's health, child's loss of interest, travel, pet's age, conflict with other pet(s), conflict with family member, marriage, moving
In consideration of the opportunity to adopt the animal(s) set forth herein, I agree to the following and to the waiver and release set forth herein. *
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. I am aware that The Animal Haven cannot guarantee the health and/or temperament of the animal(s) that I am interested in adopting. *
I hereby agree that I, and my assignees, heirs, guardians, and legal representatives, will not make a claim against or sue The Animal Haven or its employees, officers, directors, agents, volunteers and/or contractors for any damages, including personal injuries or property damage, caused by the animal and/or resulting from my adoption of the animal, and I hereby waive any such claims. *
I HEREBY RELEASE AND DISCHARGE THE ANIMAL HAVEN AND ITS OFFICERS, EMPLOYEES, AGENTS, DIRECTORS, VOLUNTEERS AND CONTRACTORS FROM ALL ACTIONS, CLAIMS, OR DEMANDS THAT I, MY HEIRS, GUARDIANS, AND/OR LEGAL REPRESENTATIVES NOW HAVE, OR MAY HAVE IN THE FUTURE, FOR ANY PERSONAL INJURIES, PROPERTY DAMAGE AND/OR OTHER DAMAGES CAUSED BY ANY OF THE ANIMALS AT THE ANIMAL HAVEN WHEN I VISIT THE ANIMAL HAVEN , INCLUDING ANY DAMAGES DUE OR CLAIMED TO BE DUE TO ANY NEGLIGENCE OF THE ANIMAL HAVEN, ITS OFFICERS, EMPLOYEES, AGENTS, DIRECTORS, VOLUNTEERS AND/OR CONTRACTORS, AND I HEREBY WAIVER ANY SUCH CLAIMS. *
Please sign *
Date *
Please provide 2 references (names, phone numbers and relationship to you) * These must be people who do not live in your home.
*	I have contacted the veterinarians listed above and given them permission to disclose my past and current pets' veterinary records. I understand that if I do not do this the adoption coordinator will not be able to process my application. *