This application must be completed by the person who will be responsible for the care of the animal.

PLEASE NOTE: If a question does not pertain to you, please type N/A into the blank field. All fields need to have something in them in order for the form to submit. Thank you.

Most applications are processed within 24 to 48 hours by Safe Haven volunteers, and prospective adopters are then notified whether the application has been approved or denied.  If we receive multiple applications for the same pet, we will call those whose submissions came in after the first approved application, so that you may choose another pet. Also, if you've seen a pet in a foster home, and it is not on our list, please fill out the application describing the pet and where you saw it. We will process your application as soon as the pet is available for adoption.

* 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. (Type "none" if there is no spouse or partner.) *
How many years have you lived at this residence? *
Are you planning to move soon? *	Yes No
If yes, where will you be moving to? If no, type N/A *
Are you over 18 years of age? *	Yes No
Drivers License Number *
Do you own or rent your home? *	Own Rent
If you rent your home, is it a *	Single-Family Dwelling Townhouse Condominium Apartment Mobile Home N/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. (Type N/A if you own your home and do not rent.) *
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? (Type N/A if no children live in or visit your household on a regular basis.) *
Is anyone in your household allergic to dogs or cats? *	Yes No
If anyone is allergic, please indicate to which animal(s)	Dogs Cats N/A
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? *	Yes No
If yes, what was the reason? *	Adopt a pet Turn in a stray Give up pet(s) Put pet to sleep Other N/A
If you checked "Other" in the circle above, please explain here. (If you did not check "other" in the circle above, type N/A.) *
Have you adopted a pet from Safe Haven Humane Society before? *	Yes No
If yes, when? If no, type N/A. *
Where is that pet now? (Type N/A if this question does not pertain to you.) *
Why are you adopting a pet now? *	Companion for self Companion for other pet Companion for family Protection Gift Child's pet Barn cat Mouser Guard dog Hunting Other
If you checked "Other" in the circle above, please explain here. (If you did not check "other" in the circle above, type N/A here.) *
How long have you been looking for a pet? *
Is everyone in the household in agreement about getting this pet? *	Yes No
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? *	Yes No N/A
If yes, which pets do you still own? Provide the breed and name of the pet. (Type N/A if this question does not pertain to you.) *
If you no longer own these pets, where are they now? (Type N/A if this question does not pertain to you.) *
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? *	Yes No N/A
How much time each day will someone be at home with this pet? *
Do you have a fenced in yard? *	Yes No
If yes, what type of fence do you have?
How will you confine this pet when you are not at home? *	Fenced yard On a chain outside In the garage In the house In an indoor kennel In an outside run Other
If you checked "Other" in the circle above, please explain here. (If you did not check "Other" in the circle above, type N/A here.) *
Will this pet live inside only, inside/outside, or outside only? *	Inside Only Inside/Outside Outside Only
Please explain the living situation of your pets who are are inside/outside or outside only pets. *
When your dog(s) are outside for long periods of time, is shelter available? *	Yes No N/A
If yes, what kind of shelter? (Type N/A if this question does not pertain to you.) *
Have you had a pet die of distemper, parvo, leukemia, or unknown causes in the past six months? *	Yes No
If yes, please explain. If no, type N/A. *
May an authorized representative of Safe Haven Humane Society contact you for follow-up information about your pet and your adoption experience? *	Yes No
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. *	Yes No

I have read and agree to the Privacy Policy *

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