Christina’s Animal Safe Haven Inc.
Adoption Application
Christina’s Animal Safe Haven Inc. is dedicated to helping animals, and we couldn't do it without volunteers like you. Thank you for supporting our mission.
Please provide the name of the dog you are interested in:
If you are interested in more than one dog, please add their name as well.
Your Information
Name
*
First Name
Last Name
Email
*
example@example.com
Home Number
*
Please enter a valid phone number.
Mobile Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
-
Month
-
Day
Year
Date
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About you
How did you learn about Christina's Animal Safe Haven?
Why are you interested in adopting a dog in need?
*
Have you ever had to give up a pet?
*
Yes
No
Never had a pet before
If so, could you please explain the reason and where you took them?
*
Are you currently employed?
*
Yes
No
Retired
If yes, How many hours do you work per week?
Employer Name
How long have you been employed at this company?
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Household Questions
What type of dog are you looking to adopt? (Consider factors like hypoallergenic breeds, specific breeds, size, or any medical conditions.)
*
Do you own a home or rent?
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Home Owner
Rent
Other
Do you have access to a yard?
Yes, fenced in
Yes. no fence
No yard
If you have access to a fenced in yard, how high is the fence?
If you're renting an apartment or house, kindly share the landlord's contact information, including their name and phone number.
How many adults live in the household?
*
How many children/teenagers live in the household?
*
Do You currently have any dogs?
*
Yes
No
If so, how many?
Are they spayed/neutered?
Yes
No
Is your dog(s) kept:
Indoor
Outdoor
Both
Do You currently have any cats?
*
Yes
No
If so, how many?
Are they spayed/neutered?
Yes
No
Is your cat(s) kept:
Indoor
Outdoor
Both
Have you ever adopted a dog or cat before?
*
Yes
No
If so, could you please provide the contact information of the organization?
Where will your future dog be kept?
*
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Veterinarian Information
Name of your Veterinarian Office
*
Veterinarian's Full Name
*
First Name
Last Name
Veterinarian Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Veterinarian Phone Number
*
Please enter a valid phone number.
Veterinarian Email
*
example@example.com
Date of your first visit with this office
*
-
Month
-
Day
Year
Date
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Continue
Continue
Adoption Information
If any behavioral issues arise, are you willing to invest time to address them?
*
What types of behavioral issues would you be unwilling to handle?
*
Would it be okay for us to visit your home to do a home check?
*
Owning a dog can come with unexpected medical expenses. Are you willing and financially able to provide necessary veterinary care when needed?
Is there any additional information or comments you would like to provide?
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References
Please provide three (3) personal references (excluding family members):
Reference #1
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Reference #2
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Reference #3
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
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Your E-Signature
I understand that by signing this form, I confirm that all information provided is accurate truthful to the best of my knowledge.
Signature
*
Submit
Submit
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