Adoption Application
If you are interested in adopting a dog, please complete the adoption application below and submit it. Once received, we will look over the application and contact you!
Contact Information
1. Name: 2. Street Address: 3. City: State: Zip Code:
4. Email Address: 5. How many years have you lived at this address? Choose Less than a year One year Two years Three years Four years Five years Six years Seven years Eight years Nine years Ten or more years
6. Do you plan on moving within the next year? Choose Yes No 7. Home Phone: Cell Phone: 8. During what hours can you be reached?
Household Information
If you rent, what is the name and phone number of your landlord? 3. Name: Phone Number:
4. How many adults live in your home? Choose 1 2 3 4 5 6 7 8 9 10 or more How many children live in your home? Choose 0 1 2 3 4 5 6 7 8 9 10 or more 5. What are the ages of the children? 6. Do all the members of your household know that you plan to adopt? Choose Yes No
7. Does anyone in your household have allergies to animals? Choose Yes No
8. Who will be this animal's primary caretaker?
Current and Past Pets
2. If you no longer have any of the pets listed above, please tell us what happened to him or her. 3. Who is your current veterinarian? Veterinarian's phone number?
4. Are all of your current pets up to date on their vaccinations? Choose yes no
Animal You Wish To Adopt
I certify that I am at least 18 years of age and the information I have given is true. I recognize that any misrepresentations of facts may result in my losing the privilege of adopting a pet. I authorize any and all verifications of statements made in the application, and I understand that Pets Haven Humane Association, Inc. has the right to deny my application. I am fully aware that I am adopting a living creature and as such that Pets Haven Humane Association, Inc. is unable to guarantee the health of the animal. If this animal becomes ill, I certify that I am financially and emotionally prepared to treat this animal at my own expense. I am aware that the life expectancy for a dog is as much as 22 years and believe that I will be able to properly care for this animal for the rest of its life. If I am ever unable to continue to care for this animal, I agree to return it to Pets Haven Humane Association, Inc..