• Safe Haven Animal Rescue

• Adoption Application

• Dog's Name
• Name:
• Address:
• email address:
• Home Phone:
• Cell Phone:
• Age:
• Occupation:
• Type of Residence (home.condo,apt,mobile home, etc.
• Are there deed restrictions or weight limits?
• Rent/Own:
• Landlord information
• Pet deposit:
• Do you have a yard
• Is it fenced?
• What size is it?
• List the people residing in your home. Name, age, relationship
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• 5.
• 6.

• Your Home:

• Who will be the primary caretaker of your new dog?
• Does anyone in your household have animal related allergies?
• Would you or do you crate train?
• Where do your dogs stay during the day?
• How long will your dogs be left alone during the day/
• Where will your dogs sleep?
• Where is your designated dog area when you have company/
• Do yoiu go to the dog park/
• Do you let your dog off leash in an open area?
• Are you willing to keep your new dog on a leash for the dog's safety?
• Have you housetrained before?
• Are you willing to housetrain?
• How did you housetrain?
• Given a week to adjust to your schedule--do you need a dog that is 100% housetrained?

• Tell us about the dogs you have owned during the last 5 years.

• Name age breed altered gender years owned etc.

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• What type of personality would you like to see in a dog?
• Veternarian's Name:*
• Number*
• Are your pets on vaccines?
• Are your pets current on Heartworm Prevention?
• Are you willing to take a dog that is not reliable with children?
• physically handicapped:
• Requires ongoing medication:
• Requires continued housetraining:
• May have been abused:
• Would you take a bonded pair?

• REFERENCES:

• Name, Phone number, relationship,time known
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• 2.
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• 1. By completing this application and signing below, I certify that I am at least 21 years of age and will assume all responsibility for the care and wellbeing of the animal that I am adopting through Safe Haven. Take my dog to a vet at least once a year for an annual exam, shots, and heartworm check.. Take my dog to a vet in a timely manner if ill. Maintain proper care including monthly heartworm preventatives and flea/tick treatments.
• 2. I further agree that I will be contractually bound through adoption to Safe Haven. I will return my dog to Safe Haven and ONLY Safe Haven. If for any reason I can no longer care for the dog in a loving and humane manner.
• Signature:
• Date:
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