First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Work Phone
x

Cell Phone

What is the best phone number to reach you?*

Name of dog you are applying for*

Why do you want to adopt a dog?*

How soon do you want to adopt a dog?

List your occupation, employer name & address, and number of years at your current job. If unemployed, please explain how you will fund the costs of keeping the pet healthy including vetting and any boarding or other expenses.*

Birthdate*

Where do you live?*
Choose one: Own your home Renting home Renting Apartment Live with family

If renting, you MUST provide the name and number of landlord below.

REQUIRED if renting Type of dwelling

If you have a fence, please describe it (height, material, size, etc.).

If you have Home Owners Insurance, what are their pet policy restrictions?*

On average how many hours will you have to leave your dog alone during the day?*
Choose one: 1 hour 2-3 hours 3-5 hours 6-7 hours 8+ hours

Where will your dog stay when left alone?

Name and age of ALL occupants in household:*

If no children currently live with you, do you plan on having children or will children be visiting the household?
Choose one: Plan on having children Children visit No children in or visit home

Are any members of your household allergic to animals?*
Choose one: Yes No

If yes, please describe

List ALL current and past pets including age & breed. *

Have you ever had a pet run away?*
Choose one: Yes No

If yes, explain

Have you had to give up a pet during your lifetime?*
Choose one: Yes No

If yes, why and where did the pet go?

Describe the types of personal situations where you would consider surrendering your dog:

If other, please explain...

If you currently have a dog(s), how does he/she react to new dogs?

Are your present pets up-to-date on their annual vaccines/wellness checks?*
Choose one: Yes No N/A

Are all past/present pets spayed or neutered?*
Choose one: Yes No N/A

If no, explain

Who will have chief responsibility of your new dog? Additionally, what kind of exercise will you implement? (For example, Walking, running, dog park, daycare, yard play, etc) *

What kind of yearly veterinary care do you plan to provide?*

NAME, ADDRESS, and PHONE NUMBER of current or most recent veterinarian? *

Will you provide your dog with monthly flea/tick prevention?*
Choose one: Yes No

Will you provide your dog with monthly heartworm prevention?*
Choose one: Yes No

Do you have any breed restrictions?*

Age of dog you would consider adopting (check all that apply):

Energy level of dog you would consider adopting (check all that apply):

Size of dog you would consider adopting (check all that apply):

Describe your ideal dog.*

If considering a puppy, are you prepared to deal with the following issues: Housetraining, Chewing, Barking, Crying at night, High energy level, Nipping, Socializing, Training. ***We STRONGLY suggest enrolling in a good puppy class or getting at least one session with a trainer (especially if this is your first puppy/dog)

How would you deal with any behavioral issues that may come up?*

At what point would you be willing to take your dog to a professional trainer (not your vet he/she is NOT a trainer)?*

How much time will your dog spend outside unsupervised?

What brand of food do you plan on feeding your new dog?*

How far are you willing to travel to meet and adopt your dog once approved?

If you have tried to adopt or have adopted a pet before, which shelter/rescue/organization did you apply through?

How did you hear of The Rescue Haven Foundation?

If you answered "other" please describe below.

Is there anything else you would like to tell us?*

Please provide 2 references (only 1 can be a family member). Include Name, Phone number, and relationship to you:

By checking YES you agree to absolve The Rescue Haven Foundation and all of its representatives from any liability in reference to a dog featured on this website.*
Choose one: Yes No

By checking YES you agree that the dog is to be kept as a house pet. It shall not be sold for medical or experimental purpose, and it shall not be used for breeding.*
Choose one: Yes No

By checking YES you agree that if you are chosen to adopt a dog, you will review and agree to an adoption contract, which is wholly in the dog's best interest.

By checking YES you agree that if you ever need to relinquish the animal during its life, you will contact The Rescue Haven Foundation for its surrender.*
Choose one: Yes No

By checking YES you agree to pay the said adoption fee in full by either cash or check and pay any bank fees associated with a bounced check.*
Choose one: Yes No

I have read the above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions and sign the application can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand that The Rescue Haven Foundation reserves the right to annul the adoption and reclaim the animal. If the application passes this review, I agree to a home visit on a mutually agreed date by The Rescue Haven Foundation before an adoption decision is made. In addition, I understand the adoption decision is dependent on many factors, including but not limited to the compatibility of the family and home to the individual animal, and other applications received on this animal. I understand it is the organization's prerogative to decide which home is most appropriate and that their decision is final. First and last name:*

Date*