SafeHaven Animal Rescue Team (SafeHART)

SafeHaven Animal Rescue Team

Dog Adoption Application
SafeHaven Animal Rescue Team, a program under the Animal House Project is an all-volunteer, 501 c3, animal welfare organization dedicated to the rescue of large breed dogs, primarily Akitas. We are funded by the founding members, as well as, through fundraising efforts and public donations.

Prior to adoption, all pets will receive a wellness exam, are microchipped, medical care, if needed: which may include worming, vaccinations, and, spaying/neutering.
This questionnaire is designed to help SafeHART Adoption Team and you determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. We reserve the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions!
Name of the dog you are interested in:*
Are you aware that there will be a non-refundable adoption donation associated with the dog you are applying to adopt? Are you prepared to make the adoption donation, in full, prior to finalizing the adoption and taking the dog home?*

YesNo
Adoption Fee:*

$500 adults$575 Puppies ($75 refundable after spay/neuter)

Applicant Information
Applicant's full name:*
Your age:*
Co-Applicant's full name (if living in same household as Applicant):*
If there is only one applicant please type N/A
Your age:
Street Address:*
City, State, Zip*
Applicant's Phone:*

Area CodePhone Number
Co-Applicant's Phone:

Area CodePhone Number
Applicant's E-mail:*
Applicant's Employer: *
1) Personal reference and phone number: *
Cannot be a Family Member or Relative
2) Personal reference and phone number:*
Cannot be a Family Member or Relative

I understand that I assume full responsibility for the welfare of this pet from the date of adoption.
Date*

MonthDayYear
Date
By submitting this form electronically, I acknowledge this as my signature.
Should be Empty:

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SafeHaven Animal Rescue Team