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.Format: (000) 000-0000.

Home Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

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.Format: (000) 000-0000.

Name of pet you are applying to adopt:

Would this be your first pet?

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:

Current Pet #1 Age

Current Pet #1 Spayed/Neutered:

If Medical Exception, Please Explain:

Current Pet #1 Current on Vaccinations:

If No, Please Explain

Current Pet #2 Name

Current Pet #2 Breed

Current Pet #2 Sex:

Current Pet #2 Age

Current Pet #2 Spayed/Neutered:

If Medical Exception, Please Explain:

Current Pet #2 Current on Vaccinations:

If No, Please Explain

Current Pet #3 Name

Current Pet #3 Breed

Current Pet #3 Sex:

Current Pet #3 Age

Current Pet #3 Spayed/Neutered:

If Medical Exception, Please Explain:

Current Pet #3 Current on Vaccinations:

If No, Please Explain

Do you have a veterinarian:

Veterinarian Name

Veterinarian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Veterinarian Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Veterinarian Email

example@example.com

Have you ever given up, rehomed, surrendered, or sold a pet in the past?

If yes, please provide details

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

Under what circumstance would you return this pet?

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?

Do you live in a:

If you rent, please provide your Lease Agreement:

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.

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

Describe the activity level in your home:

Other

What type of enclosure are you planning to use for the pet and where will they live?

How much time will they spend in the enclosure?

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?

Other

How much time can you spend with the pet?

Other

How much time will they be allowed to run around?

Other

Are you willing to take the time to work with the pet on housebreaking or chewing, or BAD BEHAVIOR, if such problems arise?

If yes, how?

Are you willing to care for the pet and take responsibility for it for the rest of its life?

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

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

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

Other

You MUST provide us with two (2) References:

Reference #1 Name

First NameLast Name

Reference #1 Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Reference #1 Email

example@example.com

Reference #2 Name

First NameLast Name

Reference #2 Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

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.

Signature