Dog Adoption Application

Animal(s) you are interested in adopting *
Applicant's First Name *
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? *
What happened to them? (If deceased, how did the pet die?) *
Are your pets current on their vaccinations? * rabies and distemper
Have you ever surrendered your dog or cat to a shelter? *
If yes, please explain? *
Veterinarian's Name * If you have never owned a pet please tell us where you would go.
Veterinarian's Address, City, State, and Zip Code * Again if you have never owned a pet please list where you would go
Veterinarian's Phone Number * Please call ahead of time to let them know that we will call
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
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
Please provide a description of this pet's living conditions. *
If no, please explain: *
Will this dog be predominantly living inside, outside, or both? *
Are there times when the dog will be tied/chained up? *
If yes, when 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? *
If you drive a pick up truck, would you allow the animal to ride in the back/bed?
If you answered "other" above, please explain: *
How will you handle housebreaking, 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 and number) *
Are you willing to take responsibility for this animal for the next 10-20 years? *
Will you allow us to perform a home check? *
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
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. *
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 understand that although the animal appears healthy, he/she may have undiagnosed problems or be incubating an infectious condition or other disease. *
Upon signing this Agreement, I assume full responsibility for the care and welfare of the animal(s) set forth in herein (these animal(s) are hereinafter referred to as the "animal"). I agree to provide the animal with nutrition, exercise, affection, and all routine and required veterinarian services and to ensure that the animal is licensed to the extent required by state law. I agree to provide The Animal Haven with access to the animal if, in The Animal Haven's sole discretion, it deems it necessary to examine or inquire about the animal. I understand that The Animal Haven may reclaim the animal if The Animal Haven determines that he or she is being neglected or abused in any way. I agree to relinquish all rights to the animal and return him/her to The Animal Haven if prior ownership is established. *
I understand that the animal may be confused, nervous and/or scared when he/she arrives at my home, that his/her habits may change in a new environment, and that I should allow at least 60 days for the animal to adjust to his/her new home. I understand that after arriving home with me, the animal could show signs of sickness from a virus or other condition to which he/she may have been exposed at the shelter (or elsewhere) or from the stress of being in a new environment. *
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 agree that upon signing this Agreement, I shall be fully responsible for the animal and any expenses incurred, including veterinarian expenses, on his/her/ behalf. I also assume full responsibility for any damage done by the animal once he/she comes home with me. I understand and agree that upon my signing this agreement, The Animal Haven will not pay for or contribute toward any expenses incurred on behalf of or due to the behavior of the animal, including any veterinarian expenses. I understand that The Animal Haven does not guarantee or warrant the health, temperament, disposition, or behavior of the animal, and I agree to accept the animal with this understanding. *
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 THE ANIMAL AND/OR RESULTING FROM MY ADOPTION OF THE ANIMAL, 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. I ALSO AGREE TO INDEMNIFY THE ANIMAL HAVEN WITH RESPECT TO ANY SUCH CLAIMS BY THIRD PARTIES, AND I ASSUME THE RISK OF AND FULL RESPONSIBILITY FOR ANY SUCH INJURIES OR DAMAGES. *
I understand that The Animal Haven has the right to reclaim the animal if I fail to comply with the provisions of this agreement or if any of the information provided in my Adoption Application is found to be untrue, incorrect, or incomplete. *
I also agree that if, for some reason, this adoption does not work out and I do not want to keep the animal, I will contact The Animal Haven and will return him/her to The Animal Haven, although I will not be entitled to a refund of the adoption fee paid upon the signing of this Agreement. I also understand that The Animal Haven may not be able to take the animal back, due to space limitations or other considerations. If The Animal Haven is not able to take the animal back, it will do its best to suggest alternative options. I also understand that the animal may not be sold, traded, surrendered or given away for any reason without prior notice to and the written consent of The Animal Haven. *
Please sign *
Date *
Please provide 2 references (names, phone numbers and relationship to you) * ANY APPLICATION WITHOUT 2 COMPLETE REFERENCES WILL BE DENIED