Adoption Application

This application must be completed by the person who will be responsible for the care of the animal. If you have pets we will need to talk to your vet to verify current vaccinations and spay/neuter status. We also contact references so that we can be assured each pet we adopt out is going to a great home.


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 48-72 hours by Safe Haven volunteers. Prospective adopters are then notified whether the application has been approved or denied. If you're approved your application is good for 6 months. If we receive multiple applications for the same pet, we will contact later applicants to see if we can find another pet for them. 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. This may occur when we have puppies or ill/injured dogs that aren't yet ready for adoption.

You can be assured that a dog you adopt from Safe Haven will have been heart worm tested, microchipped and on heartworm and flea prevention. Cats have been FeLV/FIV tested. Dogs and cats both are vaccinated as appropriate for their age, treated for any apparent internal and external parasites, spayed/neutered and have been examined by a vet to assess general health.

* Required fields
Name *
E-mail Address *
What is/are names of pets you are interested in? *
Please describe the pet you are you interested in adopting, including breed, size, 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? *
If yes, where will you be moving to? If no, type N/A *
Are you over 18 years of age? *
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. (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? *
If anyone is allergic, please indicate to which animal(s)
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. (If you did not check "other" in the circle above, type N/A.) *
Have you adopted a pet from Safe Haven Humane Society before? *
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? *
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? *
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. (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? *
Have you had a pet die of distemper, parvo, leukemia, or unknown causes in the past six months? *
Please list names and phone numbers of veterinarians who have records of the spay/neuter/vaccinations for your pets. *
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. (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? *
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? *
If yes, what kind of shelter? (Type N/A if this question does not pertain to you.) *
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? *
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. *


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Safe Haven Humane Society
P.O. Box 55, Ionia, MI 48846
Phone: 616-522-1611
Fax: 517-579-5948