S.A.F.E. Animal Haven

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see our
adoptable pets!

Animal's Name:

Adopter's Name:

Date of Birth:

Co-Adopter's Name:

Date of Birth:

Physical Address:

City:

State:

Zip:

Home Phone:

Email:

Work Phone:

Place of Employment:

Cell Phone:

How did you hear about us?:

Personal Reference:

Phone:

Do you:

OwnRentLive with ParentsLive with Grandparents

Landlord/Complex Name:

Phone:

Number of Adults in Household:

Number of Children in Household:

Ages:

Why do you want this dog?

If other, why?

Has everyone in the household agreed to take on the responsibility of a pet?

YesNo

Is anyone in the household allergic to pets?

YesNo

If yes, how will allergies be handled?

Is this adoption a gift for someone else?

YesNo

If your new dog/puppy is not housebroken, what method will you use to train him/her?

Under what circumstances might you want to return a pet - (Examples: marriage, new baby, divorce, moving, job change, behavioral issues, financial stress)

Have you ever turned a pet into a shelter?

YesNo

If yes, please explain?

Current List of Pets Owned - Please list all pets that you currently have now.

Pets Name	Type of Animal	Sex M/F	Age	Spayed/Neutered	Indoor/Outdoor	Heartworm Prevention	Flea Prevention?	Current on shots?

Previous List of Pets Owned - if an animal is no longer with you, please let us know why. If deceased, please indicate cause of death.

Pets Name	Type of Animal	Sex M/F	Spayed/Neutered	Indoor/Outdoor	Heartworm Prevention	How long did you have the pet?	What happened to this pet?

Where will this pet live?

IndoorsOutdoorsBoth

If both, how many hours indoors?

How many hours outdoors?

What type of fencing do you have?

Chain Link Split Rail Wrought Iron Privacy Fencing Aluminum Invisible Fencing Outside Kennel Tie Out No Fencing

Height of Fence:

Approximate size of fenced area:

If no fencing, how will the pet be exercised or taken on potty breaks?

How many hours will pet be alone?

Where will pet stay when alone?

Where will the pet sleep at night?

Are there times when the dog will be tied up?

YesNo

If yes, when?

Will the dog spend anytime in the garage?

YesNo

If yes, when?

If you go away for a few days, or on a vacation, who will take care of the dog?

Your current veterinarian?

Phone:

Your previous veterinarian?

Phone:

Are the records in a different name?

How long do you intend to keep this animal?

How much are you willing to spend on medical bills for your dog?

What would you do if the vet bills went over this amount?

If you move, are you willing to bring this animal to live with you in your new residence?

YesNo

Are you prepared for the costs of owning a pet? This would include food, yearly vaccinations, medical care, grooming, routine check-ups, etc.

YesNo

Are you aware that this animal requires a lifetime commitment and that this animal may live 15 years or longer?

YesNo

S.A.F.E. Animal Haven's adoption policy states that if the adoption does not work out for some reason, you agree to return the animal to us. Will you comply?

YesNoMaybe

S.A.F.E. Animal Haven's funds are very tight due to the high cost of veterinary care. Therefore, after a seven (7) day trial period, we have a 'no refund' policy. Is this acceptable to you?

YesNoMaybe

Do you agree to participate in follow-up calls and/or visits from S.A.F.E. Animal Haven volunteers/representatives?

YesNo

Do you have any additional comments?:

I hereby confirm that the information supplied here is truthful. I understand that S.A.F.E. Animal Haven may refuse adoption for any reason or may confiscate an animal at any time if the information given here is deemed incorrect or if the animal is not being cared for properly. I further understand that if I cannot keep this animal for any reason, I will contact S.A.F.E. Animal Haven and make arrangements to return the animal so that S.A.F.E. Animal Haven can place the animal in another suitable home. By submitting this application, you give S.A.F.E. Animal Haven the right to do veterinary checks as well personal reference checks.

PLEASE BE AWARE THAT YOU MUST BE 21 YEARS OF AGE AND LIVE WITHIN 1 HOURS DRIVING DISTANCE FROM CHARLOTTE, NC TO ADOPT FROM OUR GROUP. YOU WILL NOT BE APPROVED IF YOU LIVE OUTSIDE THE DRIVING LIMIT.