Adoption Application

Adoption Application

Please complete the form below to start the process of becoming an approved adopter with Miri's Haven Senior Dog Rescue. PLEASE NOTE: Primary adopter must be at least 21 years old - We DO NOT place dogs on a first come, first serve basis - Thorough veterinary reference checks will be done and vaccines and preventatives are required -Photos of your current home and pets will be required. - We do not permit the use of an invisible fence with our dogs - We do not adopt to homes that welcomed a new dog in the last 6 weeks or plan to adopt again within 6 weeks
Date*

MonthDayYear
Date
Full Name*

First NameLast Name
E-mail*
example@example.com
Co-Adopter name (if applicable)

First NameLast Name
Which dog(s) are you interested in (or apply for pre-approval and we’ll help match you):*
Please make sure to read through the Petfinder bio completely for more information on the dogs
Would you like to continue the application process if above listed dog isn’t available?*

YesNo
Applicant Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Phone Number*
Can we text you at the number(s) above?*
What Type of Home do you live in?*

Apartment/CondoTowhouse/ RowhomeSingle Family/ Detached HomeOther
Do you own your home?*

YesNoLive with family
How long have you lived at this address?:*
Name and phone # of landlord or property management company:*
Does your landlord have pet restrictions? If so, what are the restrictions?*
Are you aware of any local requirements or restrictions regarding allowed breeds, number of pets, and required vaccinations for your area?

yesno
Occupation:*
Name and age of ALL occupants in household (including yourself):*
Please list all residents of the home, age and relationship to adopter
If no children, do you plan on having children or will children be visiting the household frequently?*

YesNo
Are any members of your household allergic to animals?*

YesNo
If yes, please explain:*
How many dogs do you have currently?*
Over the past 5 years, how many pets have you owned?*
List Current Pets or most recent pets name, age, breed*
Are your pets spayed or neutered?*

YesNoN/A
My pets are current on the following; Please check all that apply*

Annual Wellness ExamHeartworm and Tick-borne illness testHeartworm, flea and tick preventatives (heartgard, nexgard, simparica trio etc)Rabies VaccineBordatella VaccineDistemper VaccineI do not have a pet currentlyOther
If not current, please explain:*
Will you provide your dog with monthly heart worm/flea/tick prevention?*

YesNo
What brand pet food do you feed your pets? *
Quality nutrition is vital for a healthy senior dog!
If you currently own a dog or cat, how does he/she react to new pets? Have they had another pet share their home?*
Have you ever lost or rehomed a pet?*

YesNo
If yes, please explain:
Do you have a fully fenced in and secured yard?*

YesNo
How tall is your fence?:*
Do you have a dog door leading outside?*

YesNo
Do you have locks and/or latches on all your gates?*

YesNoN/A
Do you have a pool or hot tub? If yes, please describe any fencing or security features:
Tell us about your typical schedule, both weekdays and weekends: How often will your new pet be left alone?
Where will the dog be kept when alone?*
Will your new dog receive walks regularly? If no, please explain:*
Will you be able to provide a new dog socialization, play-time (if applicable) and enrichment activities?*
Where will your dog sleep?*
If your dog displays behavioral problems (such as jumping on people, excessive barking, potty accidents, etc.) how would you go about correcting the behavior?*

Contact a ProfessionalUse a bookPersonal KnowledgeOther
If other, please explain:*
Do you have experience caring for senior and special needs dogs?
Are you planning on moving in the next year*

YesNo
If yes, what are your plans for your pet(s) if you move?
What plans do you have for your new pet when you are on vacation?*
Is your entire immediate family in agreement with the decision to bring a new pet into your home?*

YesNo
If adult co-adopters, what would your plan be if the relationship were to end?
Have you or any member of your household ever been charged with cruelty to animals or negligence in animal care?*

YesNo
If yes, please describe:*
Name of Veterinary Office where recent pets are seen: *
We will call for a veterinary reference check
Veterinary Practice Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Veterinarian Phone Number
I acknowledge and consent to Miri's Haven volunteers contacting my veterinarian. Understand that we cannot process your application if consent is not given.*

YesNo
Please provide 2 personal references (cannot be a relative) that can testify to your responsibility and ability to care for your animals and has been to your home. This is required or your application cannot be approved.

Recommendation: Groomers and dog walkers you have used before make excellent references. Please let your references know that you have listed them so that they are prepared to talk with us.
Reference #1*
First and Last Name & Relationship to Self
Reference # 1 Phone Number*
Reference #2*
First and Last Name & Relationship to Self
Reference #2 Phone Number*
Do you plan to welcome an additional person and/or pet into your home in the next 6 weeks, or have you welcomed a pet into your home in the past 6 weeks? If yes, please explain:*
Are you currently working with other rescues to find a dog or have you applied with any other shelter or rescue organization in the past year? If so, what was the outcome?*
We are going to ask you to upload some photographs. While we prefer you load them here, if you are having difficulty doing so, you may email them to mirishavenadoptions@gmail.com within 24 hours. Please be aware that we will not start processing your application until we have received all necessary components.
Please upload a picture taken within the last 30 days for each of your pets.

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Please upload a few pictures of each of the following items: the exterior of your home (front/back as applicable), living areas in your home such as bedrooms, living room, and any areas your pet will have access to. Please also include photos of your yard(s), and any fencing you may have.

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Please upload a picture of your drivers license or ID*

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If there is anything else you think we should know, please note it here:
How did you hear about us?
Please verify that you are human*
Signature

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We are an all volunteer rescue. Please be patient as it may take us a few days to reply by email to your application.

Thank you for your interest in adopting a senior dog!
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Adoption Application

Please provide 2 personal references (cannot be a relative) that can testify to your responsibility and ability to care for your animals and has been to your home. This is required or your application cannot be approved.

We are an all volunteer rescue. Please be patient as it may take us a few days to reply by email to your application.