Country Acres Safe Haven Adoption Application
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Continue
Name and age of everyone in the household:
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Type of home
*
House
Condo
Apartment
Mobile/trailer
Do you:
*
Own
Rent
If you rent, list name and number of landlord:
Who will be responsible for taking care of the dog?
*
Why do you want to adopt a dog?
*
Name of dog you're interested in adopting:
*
Are you prepared for the time it will take to train, exercise, socialize, and love a new pet?
*
Yes
No
Are you prepared for the financial considerations of owning a pet (food, toys, vet bills, preventative medications)?
*
Yes
No
Where will the dog be located when you are not home?
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Inside
Outside
Crate
Where will the dog be when someone is home?
*
Inside
Outside
Crate
How long will the dog be left home alone?
*
Do you have a fenced yard?
*
Yes
No
If you have a fenced yard, how tall is the fence?
Is the fence secure?
Yes
No
List any cats or dogs you have had in the last 5 years and include breed, current status(living vs deceased), sex, if they are spayed/neutered, if they are UTD on vaccines, and do you still own?
*
List current vet, phone number, and name records can be found under.
*
List 2 references and their phone numbers.
*
Have you ever surrendered a pet to a shelter?
*
Yes
No
If yes above, please explain
Have you ever been charged/investigated for animal abuse, cruelty, or neglect?
*
Yes
No
Are you willing to give the dog time to adjust to a new environment/family members?
*
Yes
No
How will you introduce the new dog to existing pets in the house?
*
If you took a dog home and you were having issues in the first few days to weeks, would you be willing to try and work through issues or would you return the dog?
*
Work through
Return the dog
If an unfortunate event was to happen to the main caretaker, what would happen to the dog?
*
Signature
*
Should be Empty: