All for the Love of Jax Safe Haven Adoption Application

All for the Love of Jax Safe Haven Adoption Application
In order to be considered to adopt a rescue pet, you must:
- Have a Valid California Identification (for each family member over 18) showing your present address (ex. Driver's license or NRIC) for vertification purposes only
- Must live within 3 hours of the Modesto area
- AGREE/COMPLY TO A HOME CHECK
  - Home inspections must be cleared (APPROVED) by all board members before adoption is complete
- Be able and willing to provide a loving, safe and peaceful environment for the pet
- Be able and willing to spend the time and money necessary to provide training, medical treatment and proper care for the pet
- Be 21 or older *If you are under 21 years, a parent or legal guardian is required to complete the form
- Have the consent of your landlord if you currently rent
***PLEASE ANWER EVERY QUESTION. IF A QUESTION IS INAPPLICABLE WRITE N/A. ANY INCOMPLETE APPLICATION WILL BE DENIED.
Name

First NameLast Name
Age(s)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone Number
Please enter a valid phone number.
Home Phone Number
Please enter a valid phone number.
Email
example@example.com
EMPLOYER'S INFORMATION

If not currently employed, please indicate your source of income. Example: retired, disabled, full time student, etc
Employer Name
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer Phone Number
Please enter a valid phone number.
Name of pet you are applying to adopt:
Would this be your first pet?

YesNo
Describe in detail why you wish to adopt the pet:
*ANY CURRENT PET IS REQUIRED TO BE ALTERED IN ORDER TO ADOPT FROM ALL FOR THE LOVE OF JAX SAFE HAVEN*
Current Pet #1 Name
Current Pet #1 Breed
Current Pet #1 Sex:

MaleFemale
Current Pet #1 Age
Current Pet #1 Spayed/Neutered:

YesNoMedical Exception
If Medical Exception, Please Explain:
Current Pet #1 Currently on Vaccinations:

YesNo
If No, Please Explain
Current Pet #2 Name
Current Pet #2 Breed
Current Pet #2 Sex:

MaleFemale
Current Pet #2 Age
Current Pet #2 Spayed/Neutered:

YesNoMedical Exception
If Medical Exception, Please Explain:
Current Pet #2 Currently on Vaccinations:

YesNo
If No, Please Explain
Current Pet #3 Name
Current Pet #3 Breed
Current Pet #3 Sex:

MaleFemale
Current Pet #3 Age
Current Pet #3 Spayed/Neutered:

YesNoMedical Exception
If Medical Exception, Please Explain:
Current Pet #3 Currently on Vaccinations:

YesNo
If No, Please Explain
Do you have a veterinarian:

YesNo
Veterinarian Name
Veterinarian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Veterinarian Phone Number
Please enter a valid phone number.
Veterinarian Email
example@example.com
Have you ever given up, rehomed, surrendered, or sold a pet in the past?

YesNo
If yes, please provide details
Under what circumstances would you return this pet?

New JobNew BabyIllnessDivorceMoveOther
Have you ever applied to adopt an animal in the past?

YesNo
If so, when and with what rescue or shelter?
How many adults are in your family?
How many children are in your family?
What are the ages of the members of your family?
Does any member of your family have any allergies to animals?

YesNo
Do you live in a:

Home - OwnHome - RentApartmentOther
If you rent, please provide your Lease Agreement:

Cancelof
Is your home pet proof? i.e. electric cords are picked up, there are no chemicals on the floors, plants that are poisonous to pets have been removed from the pet's living space, etc.

YesNo
A home inspection is required & must be PASSED. Do you agree to allow a representative into your home to perform one?

YesNo
Describe the activity level in your home:

Busy (visits by friends, meetings children, parties at home)Noisy (TV, stereo, machinery, tools, children playing, dogs barking)Quiet (homebodies, few guests)Other
What type of enclosure are you planning to use for the pet and where will they live?

KennelCrateGated off in a room of the houseGarageOutside unsupervisedOther
How much time will they spend in the enclosure?

2-4 Hours5-8 Hours
How much time are you prepared to allow for your new pet(s) to adjust to your pets, children & home?
How many hours a day will the pet be alone?

2-4 Hours5-8 HoursOther
How much time can you spend with the pet?

2-4 Hours5-8 HoursOther
How much time will they be allowed to run around?

2-4 Hours5-8 HoursOther
Are you willing to take the time to work with the pet on housebreaking or chewing, or BAD BEHAVIOR, if such problems arise?

YesNo
If yes, how?
Are you willing to care for the pet and take responsibility for it for the rest of its life?

YesNo
Are you willing and able to pay the veterinary costs of caring for your new pet(s)?

YesNo
Are you willing to take responsibility if this pet acquires an illness or tests positive for medical problems/issues?

YesNo
In the absence of the primary caregiver, who will care for your pet(s):

Family or FriendRehome on a Craigslist ad or post on social mediaAll for the Love of Jax Safe HavenOther
You MUST provide us with two (2) References:
Reference #1 Name

First NameLast Name
Reference #1 Phone Number
Please enter a valid phone number.
Reference #1 Email
example@example.com
Reference #2 Name

First NameLast Name
Reference #2 Phone Number
Please enter a valid phone number.
Reference #2 Email
example@example.com
I certify that all information in the application is true and I understand that false information will void the application and animal can be confiscated. I give permission to All for the Love of Jax Safe Haven to verify any information that I have given on my application. I understand that the application will become part of my adoption agreement, which is a binding document. I agree the adopted pet(s) may be removed from my home if any conditions of the adoption contract have been violated or, if in the opinion of All for the Love of Jax Safe Haven, the environment is unsafe. This is a legally binding contract and if for any reason this contracts needs to be enforced in a court of law then YOU will be responsible for all attorney's fees, legal fees, and any additional fees accrued.
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