Dog & Cat Application Get involved Adoption Saves Lives Are you looking to bring a dog or cat (or possibly both) into your home? Start the process by filling out our application. What is the name of the pet you're interested in adopting?* Your Legal Name* First Last What is your age?* Phone (cell)*Phone (home)*Email* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Have you adopted from Safe Haven previously?* Yes No Unknown Who will this pet be for?* Yourself Family Does anyone in your family/household have any known allergies to animals?* Yes No Please list the age of any children under 18 in the family/household:* Who will have primary responsibility for this pet?* Which of the following describes your current residence?* Own house with fenced yard Own house without fenced yard Rent/Lease house with fenced yard Rent/Lease house without fenced yard Rent apartment/condo/townhouse How long have you lived at this residence?* What are your plans for your pet when you are away during the day (at work, etc.)?*Adult Pet Ownership: I DO NOT CURRENTLY OWN ANY PETS. Please list all of the animals currently living in your household, if applicable. Please include the species, breed, sex, and age for each.Are your pets spayed/neutered?* Yes No I don’t know Not applicable (no pets) If no, why not? What behaviors are unacceptable in a pet?*Do you have livestock?* Yes No If so, what kind?Please provide two references.Include the name, address, email address and phone number for each.Personal Reference #1*Personal Reference #2*Do you have a veterinarian you have used before or have lined up to use after you adopt your new pet?*If you have a vet or have selected a vet, please provide his or her name, clinic name and phone number. If you don’t currently have a vet because you don’t currently have any pets, please put “n/a.”May we call your veterinarian as a reference?* Yes No N/A If you do not have a veterinarian would you like us to recommend one?* Yes No thanks What additional questions, concerns or comments do you have regarding this adoption?Would you like to sign up for our email newsletter? We'll never share, sell or use your email address for anything other than occassional emails about Safe Haven activities. You can unsubscribe at any time.* Yes, sign me up No thanks Please type your name. This serves as your signature, agreeing that you have provided accurate information to the best of your ability.* PhoneThis field is for validation purposes and should be left unchanged. Δ
