* Required fields
Name *
E-mail Address *
Please describe the pet you are you interested in adopting, including breed, name, etc. *
Your address (including city and zip code) *
Home telephone number *
Work telephone number *
Cell phone number
Your spouse/partner's Name *
How many years have you lived at this residence? *
Are you planning to move soon? *
If yes, where will you be moving to?
Are you over 18 years of age? *
Drivers License Number *
Do you own or rent your home? *
If you rent your home, is it a
If you rent your home, please provide the name and phone # of the responsible property manager who will approve your having this pet at the property. *
Number of adults who live in your household *
Number of children who live in your household *
What are the ages of the children living in or visiting your household on a regular basis? *
Is anyone in your household allergic to dogs or cats? *
If anyone is allergic, please indicate to which animal(s)
Please provide the full name and telephone number of any veterinarian who would have records of treatment of any pet you have owned within the past five years. *
Have you used an animal shelter or humane society before? *
If yes, what was the reason?
If you checked "Other" in the circle above, please explain here. *
Have you adopted a pet from Safe Haven Humane Society before? *
If yes, when? *
Where is that pet now? *
Why are you adopting a pet now? *
If you checked "Other" in the circle above, please explain here. *
How long have you been looking for a pet? *
Is everyone in the household in agreement about getting this pet? *
How many dogs have you owned in the past 5 years? *
How many cats have you owned in the last 5 years? *
How many other types of pets have you owned in the past 5 Years? What were they? *
Do you still own any of these pets? *
If yes, which pets do you still own? Provide the breed and name of the pet. *
If you no longer own these pets, where are they now? *
How many of your pets are/were spayed or neutered? Please indicate cat, dog, or other, and how many of each were spayed or neutered. *
Are/were your pets' shots kept up to date? *
How much time each day will someone be at home with this pet? *
Do you have a fenced in yard? *
If yes, what type of fence do you have? *
How will you confine this pet when you are not at home? *
If you checked "Other" in the circle above, please explain here. *
Will this pet live inside or outside? *
When your dog(s) are outside for long periods of time, is shelter available? *
If yes, what kind of shelter? *
Have you had a pet die of distemper, parvo, leukemia, or unknown causes in the past six months? *
If yes, please explain. *
May an authorized representative of Safe Haven Humane Society contact you for follow-up information about your pet and your adoption experience? *
Please provide 5 personal references. For each, include name, telephone number, your relationship to this person, and how long you have known this person. Put your first reference here: *
Put your second reference here: *
Put your third reference here: *
Put your fourth reference here: *
Put your fifth reference here: *
I believe I am capable of handling and interacting with the pet I propose to adopt and am financially able to care for it. I have answered these questions truthfully to the best of my ability. I understand that any misrepresentation of this information is grounds for adoption denial. Furthermore, I understand that completing this application is not a guarantee that I will be allowed to adopt this pet and that Safe Haven Humane Society has the right and responsibility to deny any adoption. *
