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Animal: ________________ Landlord Check: ____________
Vet Check: _____________ Home Check: _______________
SAFE HAVEN ADOPTION APPLICATION
Please fill out the entire application completely. Your application will not be processed if you leave blanks. If you rent you must supply name and phone number of your landlord. You need to have the name and phone number of your vet or the vet you intend to use.
Name: ________________________________________________________________
Address: ______________________________________________________________
City: _____________________________ State: __________ Zip: ____________
Home Phone: _____________________ Work Phone: ______________________
Cell Phone: _______________________ D.O.B.: ____________________________
Email Address: _______________________________________________________
Type of Pet you are looking for: ________________________________________
Why do you want a pet: _______________________________________________
What experience do you have with companion animals:_________________
_______________________________________________________________________
Name/Breed/Age of Current Pets: _____________________________________
________________________________________________________________________
Are They Spayed/Neutered: ___________________________________________
If not Why: ___________________________________________________________
Your Vet: _______________________ Phone #: ____________________________
How many people in your household: __________ Adults: ______________
Children/Ages: ________________________________
Do you own or rent your residence: ____________________________________
Type of residence: single family ______ duplex _______ trailer ________ apartment _______ Landlord name/phone # ___________________________
How long have you lived there: _______________ Size of yard: ___________
Is the yard fenced: __________ Type of fencing: _________________________
How high is fencing: _______________ Is it attached to your home: ______
If your yard is not fenced do you realized that a dog must be leash walked several times a day rain or shine or when you are not feeling well:
__________
How long have you been looking for a pet: _____________________________
Where else have you looked: ___________________________________________
Where will the pet be kept during the day: _____________________________
Nights: _____________________________ How many hours a day will pet be left unattended: _______________________________________________________
Does someone come in during the day to take care of pets: _____________
Does anyone in your home have pet allergies: __________________________
Are you aware of yearly costs to maintain a pet: ________________________
Are you aware of laws pertaining to licensing, required shots and leash laws in your area: _____________________________________________________
It takes at least 2 weeks for a pet to adjust to its new home, especially if you have other pets. Are you prepared to allow this much time for pet to adjust: _______________________________________________________________
Have you ever given up a pet: ________ If yes explain: _________________
________________________________________________________________________
Do you realize a pet can live 15 - 20 years: _________ Are you prepared for this: _________
How many times a year do you travel: _________________________________
Where will your pets stay: _____________________________________________
What will happen to your pet if you move: _____________________________
Change jobs: ____________________________ Have a child: _______________
________________________________________________________________________
If this is your first pet:
How will you housetrain: ______________________________________________
Have you read up on behavioral problems: _____________________________
Researched different food types: _______________________________________
Read up on crate training: ________________ Bought a crate: ____________
Would you be willing to bring your pet to obedience classes if they are recommended by Safe Haven: _________________________________________
Are you willing for one of our volunteers to do a home visit: ____________
Have you read our adoption requirements: _____________________________
Please give 3 personal references: ______________________________________
________________________________________________________________________
________________________________________________________________________
I have read all questions carefully and answered truthfully. If an omission or untruth is discovered after the adoption takes place, Safe Haven reserves the right to annul the adoption and reclaim the animal. I give Safe Haven permission to investigate all of the information that I have provided.
Some applications are declined not because of any of the information provided but because the animal they have applied for is not a good match for that home. Safe Haven will discuss this with the applicant.
I understand that Safe Haven will decide which home is most appropriate for each animal in their care and that their decision on the appropriate home is final.
Signature: ________________________________________ Date: _____________
Safe Haven
HC 1 Box 1654
Blakeslee, PA 18610