Haven of Love Dog Rescue Adoption Application
* Please Note* We place dogs based on the best fit for the dog.
Name
*
First Name
Last Name
Please name the animal(s) you are interested in
*
Phone Number
*
Please enter a valid phone number.
Age
*
Current Employer
*
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you over the ago of 18?
*
Please Select
Yes
No
Are you currently serving in the Military?
*
Please Select
Yes
No
In what type of home to you live?
*
Please Select
Single Family
Apartment
Mobile Home
Other
Do you own your home?
*
Please Select
Yes
No
If you rent:
You must list your landlord's contact information*
How many individuals live at your residence (include yourself)?
*
How many of those individuals living in your residence are above the age of 18 years (including yourself)?
*
Do you have children under the age of 18 years living in your residence ?
*
Please Select
Yes
No
How many pets have you owned in the last 10 years?
*
Are all of these pets still with you?
*
Yes
No
Please list all current pets and ages:
Write "None" if you currently have no pets
Are all current pets current on vaccinations?
*
Please Select
Yes
No
Does not apply to me
Are all current pets spayed/neutered?
*
Please Select
Yes
No
Does Not Apply to Me
Are all your current pets on heartworm preventative?
*
Please Select
Yes
No
Does Not Apply to Me
What is the name of the veterinary clinic that your current/past pets have been seen at?
How do you plan on exercising your new pet?
Where will your new animal primarily reside?
*
Please Select
Inside
Outside
Both
What type of yard/fence do you have?
*
Where will the animal reside when you're not at home?
*
Approximately how many hours a day will the animal be left alone?
*
What of the following behaviors would cause you to relinquish or return your adopted Haven of Love Dog Rescue animal?
*
Digging
Barking
Nipping
Begging
Separation Anxiety
Marking
Fence Jumping
Lack of Obedience
Destroying Possessions
Counter Surfing
Medical Needs
None of the Above
AGREEMENT
Please sign the application and agree to the following: By signing this application I agree to allow Haven of Love Dog Rescue to contact the veterinary office listed above, contact my current landlord, and set up an appointment to visit my house. I understand that by filling out this application, Haven of Love Dog Rescue reserves the right to deny my application for any reason that is not in the best interest of the dog. Should my application be approved, I understand that I must thoroughly read through and agree to Haven of Love Dog Rescue Adoption Contract. Any falsification of this application will result in denial of the application. Incomplete applications will not be processed.
Name (your typed name serves as a signature)
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: