Dog Adoption Application

Please be advised that The Animal Haven receives many adoption applications each week and does its best to review them and get back to each potential adopter as soon as possible. We will try to get back to you within two weeks, but if you do not hear from us within that time frame, please assume that the dog is no longer available for adoption or we felt that he or she was not a good fit for your particular circumstances. Thank you for thinking of our shelter when considering adopting an animal.

Name of dog or type of dog for adoption *

How did you hear about the adoptable dogs at The Animal Haven?

Personal Information

Name(s) *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Cell Phone *

Email *

I am at least 21 years of age *

Occupation *

Employer Name

Employer Address

Employer Phone Number

Household Information

Please indicate your living situation *

*If renting, we require a lease stating the pet policy or your landlord's name and phone number.
**Co-op/Condo – we require the by-laws stating the pet policy. It is our policy to verify that you can have a pet before approving your application.

How long have you lived at this address? *

Are you planning to move within the next year or two? *

What would you do with your pets if you moved? *

How many people live in your home, including yourself? *

Please provide the names and ages of all those living in your home, including yourself: *

Do all members of your household agree to the addition of a new dog to your home? *

All members of your household will have to meet the dog before your adoption application can be finalized.

If your family situation were to change (e.g., divorce, new baby, marriage), would you keep your pet(s)? *

Pet History

Please list all of your current and/or previous pets starting with the most recent: *

With respect to each pet listed above, state the following: the pet's name, age, breed, sex, whether spayed/neutered, whether indoor and/or outdoor, and whether alive or deceased *

With respect to each of your previous pets, state whether the pet was lost, given away, or surrendered to another shelter. If the pet was lost, state how the pet was lost and when. If the pet was given away or surrendered to another shelter, state to whom the pet was given away or surrendered, when and why. *

With respect to each of your previous pets that has died, state the date of the pet's death, how old the pet was when he or she died, and the cause of the pet's death. *

Veterinarian Information

Please provide the following information for all veterinarians whom you use or have used for your pets (or plan to use if this is your first pet).

Veterinarian 1

Veterinarian Name/Practice: *

Veterinarian Address: *

Veterinarian Phone Number: *

Veterinarian 2

Veterinarian Name/Practice:

Veterinarian Address:

Veterinarian Phone Number:

Veterinarian 3

Veterinarian Name/Practice:

Veterinarian Address:

Veterinarian Phone Number:

Veterinarian Authorization* (to process your application, the authorization below is required for all veterinarians that you use or have used for your pets)

I hereby state that I have contacted the veterinarian(s) listed above whom I use or have used in the past and authorized him/her/them to speak with The Animal Haven and provide any and all information that The Animal Haven requests.

More Information

What emergency hospital do you currently use or plan to use? *

Living with Your Dog

Where will you keep your dog during the day? *

Where will you keep your dog during the night? *

Where will your dog sleep? *

Do you intend to crate your dog? *

Yes
No
Maybe

If you were advised by The Animal Haven to crate your dog at first under certain circumstances, would you be willing to use a crate for your dog? *

If crating is not an option, do you have a dedicated room in your home that can be safely set up for a dog, especially at first, while no one else is at home (please explain, size, location, furniture, and other characteristics of the room)?

How many hours will your dog be alone each day? *

Please describe selection(s)

Fenced Yard: What type of fence? How high is it?
Tie-Out: What type of tie-out? How long is it? Where is it located?
Roam/Run Free: Where would the dog roam/run free?

Have you ever participated in formal obedience dog training? *

Would you be willing to take your new dog to obedience training or a behaviorist? *

Are there any circumstances under which you would give up your pet? *

Are you aware that a dog can live to be 15 years old or older? *

Are you prepared to make a lifelong commitment to your new dog? *

It may take a few weeks, or even months, for your new pet to adjust to his/her new home. Are you willing to wait out this adjustment period? *

What behaviors are you not willing to work on? (e.g., house-training, chewing, barking, digging) *

If you are applying to adopt a puppy, have you ever had a puppy before?

Do any of the residents in your home have allergies to any type of animal? *

What would you do if a family member became allergic to the dog? *

What arrangements will you make for the care of the dog in case of an emergency, if you go on vacation, or if you become temporarily unable to care for the dog? *

In whose care do you intend to leave the dog if you become permanently unable to care for the dog? (Please provide name and number) *

The Animal Haven strongly recommends that you learn as much as possible about adopting an adult dog or puppy. They require a lot of time, patience and effort. Before you adopt, please speak to our staff for information regarding dog and puppy care.

Please list questions or concerns about which you would like more information:

I hereby state that I am financially, physically and mentally able to provide adequate medical care, nutrition, exercise and affection to my new dog and will not abuse or neglect said animal in any way. I understand that The Animal Haven promotes adoption of an animal for his/her entire life. I am committing to adopting and providing a loving home to this animal for his/her entire life.

All of the aforementioned information is true, correct and complete to the best of my knowledge. I understand that my adoption application will be denied if any of the information provided is found to be untrue, inaccurate and/or incomplete.

Your Signature (I agree to sign this document electronically) (use mouse to sign) *

Date *

Adoption Agreement and Release from Liability *

In consideration of the opportunity to adopt the animal(s) set forth in my Dog Adoption Application (which is hereby incorporated herein and made part of this agreement), I agree to the terms of this agreement and the waiver and release set forth herein.

Upon signing this Agreement, I assume full responsibility for the care and welfare of each of the animals set forth in my Dog Adoption Agreement (these animal(s) are hereinafter referred to as the "animal"). I agree to provide the animal with nutrition, exercise, affection, and all routine and required veterinarian services and to ensure that the animal is licensed to the extent required by state law. I agree to provide The Animal Haven, Inc. ("The Animal Haven") with access to the animal if, in The Animal Haven's sole discretion, it deems it necessary to examine or inquire about the animal. I understand that The Animal Haven may reclaim the animal if The Animal Haven determines that he or she is being neglected or abused in any way. I agree to relinquish all rights to the animal and return him/her to The Animal Haven if prior ownership is established.

I understand that the animal may be confused, nervous and/or scared when he/she arrives at my home, that his/her habits may change in a new environment, and that I should allow at least 60 days for the animal to adjust to his/her new home. I understand that after arriving home with me, the animal could show signs of sickness from a virus or other condition to which he/she may have been exposed at the shelter (or elsewhere) or from the stress of being in a new environment. I agree that upon signing this Agreement, I shall be fully responsible for the animal and any expenses incurred, including veterinarian expenses, on his/her behalf. I also assume full responsibility for any damage done by the animal once he/she comes home with me. I understand and agree that upon my signing this agreement, The Animal Haven will not pay for or contribute toward any expenses incurred on behalf of or due to the behavior of the animal, including any veterinarian expenses. I understand that The Animal Haven does not guarantee or warrant the health, temperament, disposition, or behavior of the animal, and I agree to accept the animal with this understanding.

I understand that although the animal appears healthy, he/she may have undiagnosed problems or be incubating an infectious condition or other disease.
I have been informed that the animal has a diagnosed medical, injury, or congenital defect. I have been informed that the animal may have additional undiagnosed medical problems or can be incubating an infectious condition or other disease.

I hereby agree that I, and my assignees, heirs, guardians, and legal representatives, will not make a claim against or sue The Animal Haven or its employees, officers, directors, agents, volunteers and/or contractors for any damages, including personal injuries or property damage, caused by the animal and/or resulting from my adoption of the animal. I HEREBY WAIVE ANY SUCH CLAIMS AND RELEASE AND DISCHARGE THE ANIMAL HAVEN AND ITS OFFICERS, EMPLOYEES, AGENTS, DIRECTORS, VOLUNTEERS AND CONTRACTORS FROM ALL ACTIONS, CLAIMS, OR DEMANDS THAT I, MY HEIRS, GUARDIANS, AND/OR LEGAL REPRESENTATIVES NOW HAVE, OR MAY HAVE IN THE FUTURE, FOR ANY PERSONAL INJURIES, PROPERTY DAMAGE AND/OR OTHER DAMAGES CAUSED BY THE ANIMAL AND/OR RESULTING FROM MY ADOPTION OF THE ANIMAL, INCLUDING ANY DAMAGES DUE OR CLAIMED TO BE DUE TO ANY NEGLIGENCE OF THE ANIMAL HAVEN, ITS OFFICERS, EMPLOYEES, AGENTS, DIRECTORS, VOLUNTEERS AND/OR CONTRACTORS. I ALSO AGREE TO INDEMNIFY THE ANIMAL HAVEN WITH RESPECT TO ANY SUCH CLAIMS BY THIRD PARTIES, AND I ASSUME THE RISK OF AND FULL RESPONSIBILITY FOR ANY SUCH INJURIES OR DAMAGES.

I also agree that if, for some reason, this adoption does not work out and I do not want to keep the animal, I will contact The Animal Haven and will return him/her to The Animal Haven, although I will not be entitled to a refund of the adoption fee paid upon the signing of this Agreement. I also understand that The Animal Haven may not be able to take the animal back, due to space limitations or other considerations. If The Animal Haven is not able to take the animal back, it will do its best to suggest alternative options. I also understand that the animal may not be sold, traded, surrendered or given away for any reason without prior notice to and the written consent of The Animal Haven. I understand that The Animal Haven has the right to reclaim the animal if I fail to comply with the provisions of this agreement or if any of the information provided in my Dog Adoption Application is found to be untrue, incorrect, or incomplete.

Your Signature (I agree to sign this agreement and release electronically) (use mouse to sign) *

Date *

Driver's License #: *

Expiration Date *

Please Provide Two References

Reference 1 Name *

Reference 1 Phone Number(s) *

Reference 1 Relationship to You *

Reference 2 Name *

Reference 2 Phone Number(s) *

Reference 2 Relationship to You *

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