PLEASE BE SURE TO COMPLETE EVERYTHING.
We reserve the right to choose who adopt our dogs and puppies. It is not first come first serve.
Also please do not fill out an application if you have any animals that have not been spayed or neutered this is an automaic denial. For questions about your application please call 330-717-1118
If interested in adopting one of our babies, please copy this application into an email and send it, completed, to [email protected] Status____________________
Requirements________________________________
Landlord Check____________ Vet Check_________ Animal___________________
Yard Check_________________________________ Safe Haven Rescue New Middletown OH
Name:__________________________________________________________________
Address:________________________________________________________________
City:_____________________________________State:____________Zip:___________ Home Phone:_____________________WorkPhone:____________________Age:______
Email Address: ___________________________________________________________
1. What type of pet are you looking for? DOG CAT MALE FEMALE ADULT PUPPY KITTEN Size:________________________________
2. Do you want a particular breed? If yes, what breed?________________________
3. Do you want this pet for: COMPANION PROTECTION BREEDING GIFT OTHER__________________________
4. This pet will be without human companionship for about ____________ hours per day, ______________days per week.
5. Where will your pet be kept during the day? (circle all that apply) INDOORS OUTDOORS DOG PEN CRATE BASEMENT GARAGE OTHER______________________
During the night? INDOORS OUTDOORS DOG PEN CRATE BASEMENT GARAGE OTHER________________________
6. Why do you want a puppy/dog? _____________________________________________________________________________________________________________________
7. Where do you live? HOUSE APARTMENT CONDO TRAILER OTHER______
_________I RENT ________I OWN ________WITH MY PARENTS
Landlord’s name:______________________________Phone:________________
8. Does your landlord allow pets? YES NO DON’T KNOW Deposit required?____________________ Monthly rent increase?___________
9. Do you have a fenced yard? YES NO
If fenced, please describe the height and type:____________________________
10. Please provide the following information about your household: Number of adults:________Number of children:________Ages:______________
11. Is anyone in your family allergic to animals?_____________ CATS DOGS
12. What will you do with your pets if you move in the future:__________________ _________________________________________________________________
13. How much do you anticipate spending yearly to feed, vaccinate, license and provide medical care for your pet?______________________________________
14. Would you be willing to allow a representative from the shelter visit your home before the adoption is completed?______________________________________
15. Have you adopted an animal from us before?_____________________________
16. What type(s) of pets do you own or have owned in the last 10 years?
Please list animal, whether you still own it, spayed or neutered? and age._____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
17. Who is (was) your veterinarian for the above animals? If you do not have any pets now, please establish a vet and list that information. Name:________________________________Phone:_______________________
18. Did/Do you provide regular heartworm preventative and flea treatment for the animals? YES NO
20. Do you realize that a dog or cat may live 15 or more years? YES NO
21. It may take your new pet three or more weeks to adjust to its new home, especially if other pets are involved. Are you prepared to allow this much time? YES NO
22. How do you plan to house train your dog?______________________________ ________________________________________________________________
23. Are you willing to take the adopted animal to obedience training if needed? Yes NO
By signing below, I certify that the information I have given is true and that I recognize that any misrepresentation of the facts may result in my losing privilege of adopting a pet. I authorize investigation of all statements on this application.
Signature:_____________________________________________Date:______________
Although we have every dog vet checked, shots and wormed, we do not offer a health gaurentee. We will disclose any information that we have on the health of the animal prior to adoptions.
We reserve the right to choose who adopt our dogs and puppies. It is not first come first serve.
Also please do not fill out an application if you have any animals that have not been spayed or neutered this is an automaic denial. For questions about your application please call 330-717-1118
If interested in adopting one of our babies, please copy this application into an email and send it, completed, to [email protected] Status____________________
Requirements________________________________
Landlord Check____________ Vet Check_________ Animal___________________
Yard Check_________________________________ Safe Haven Rescue New Middletown OH
Name:__________________________________________________________________
Address:________________________________________________________________
City:_____________________________________State:____________Zip:___________ Home Phone:_____________________WorkPhone:____________________Age:______
Email Address: ___________________________________________________________
1. What type of pet are you looking for? DOG CAT MALE FEMALE ADULT PUPPY KITTEN Size:________________________________
2. Do you want a particular breed? If yes, what breed?________________________
3. Do you want this pet for: COMPANION PROTECTION BREEDING GIFT OTHER__________________________
4. This pet will be without human companionship for about ____________ hours per day, ______________days per week.
5. Where will your pet be kept during the day? (circle all that apply) INDOORS OUTDOORS DOG PEN CRATE BASEMENT GARAGE OTHER______________________
During the night? INDOORS OUTDOORS DOG PEN CRATE BASEMENT GARAGE OTHER________________________
6. Why do you want a puppy/dog? _____________________________________________________________________________________________________________________
7. Where do you live? HOUSE APARTMENT CONDO TRAILER OTHER______
_________I RENT ________I OWN ________WITH MY PARENTS
Landlord’s name:______________________________Phone:________________
8. Does your landlord allow pets? YES NO DON’T KNOW Deposit required?____________________ Monthly rent increase?___________
9. Do you have a fenced yard? YES NO
If fenced, please describe the height and type:____________________________
10. Please provide the following information about your household: Number of adults:________Number of children:________Ages:______________
11. Is anyone in your family allergic to animals?_____________ CATS DOGS
12. What will you do with your pets if you move in the future:__________________ _________________________________________________________________
13. How much do you anticipate spending yearly to feed, vaccinate, license and provide medical care for your pet?______________________________________
14. Would you be willing to allow a representative from the shelter visit your home before the adoption is completed?______________________________________
15. Have you adopted an animal from us before?_____________________________
16. What type(s) of pets do you own or have owned in the last 10 years?
Please list animal, whether you still own it, spayed or neutered? and age._____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
17. Who is (was) your veterinarian for the above animals? If you do not have any pets now, please establish a vet and list that information. Name:________________________________Phone:_______________________
18. Did/Do you provide regular heartworm preventative and flea treatment for the animals? YES NO
20. Do you realize that a dog or cat may live 15 or more years? YES NO
21. It may take your new pet three or more weeks to adjust to its new home, especially if other pets are involved. Are you prepared to allow this much time? YES NO
22. How do you plan to house train your dog?______________________________ ________________________________________________________________
23. Are you willing to take the adopted animal to obedience training if needed? Yes NO
By signing below, I certify that the information I have given is true and that I recognize that any misrepresentation of the facts may result in my losing privilege of adopting a pet. I authorize investigation of all statements on this application.
Signature:_____________________________________________Date:______________
Although we have every dog vet checked, shots and wormed, we do not offer a health gaurentee. We will disclose any information that we have on the health of the animal prior to adoptions.
