Name of dog or type of dog for adoption * Personal Information Name(s) * 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: * 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 current and/or previous pets in your home starting with the most recent: * For each pet, please list the following: Name Age Breed Sex Spayed/Neutered Indoor and/or Outdoor Alive/Deceased If Deceased, When? 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 when the pet died, 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) 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? * 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? * How do you plan to exercise your dog? * 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? * If yes, under what circumstances would you give up your pet? (Check all that apply) 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? * What arrangements will you make for the care of the dog if you became permanently unable to care for the dog? * If you intend to leave the dog in someone else's care, please provide that person's 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: Adoption Agreement and Release from Liability * 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 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. 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 *