Name
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First Name
Last Name
Phone Number
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Email
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Date of Birth
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* All applicants must be over the age of 18
MM
DD
YYYY
What is the name of the animal you are interested in adopting?
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Please describe in detail your reason for choosing this animal.
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What are you looking for in a dog/cat and what personality type do you think suits your family?
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How many adults are in your household?
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How many children (under 16) are in your household? Please list ages
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Do you have any medical issues that may affect the care of the animal?
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Please describe your lifestyle (active, not active, outdoors etc)
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What hours do you work? (Full-time, Part-time, Casually)
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Would this be your first pet?
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Please tell us about all other pets and animals in your home. How many, their age, breed etc.
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Please tell us about the pets you have had in the past. Include age, sex, breed etc
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Are your current pets desexed?
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Yes
No
Don't have any other pets
Are your current pets up to date with vaccinations?
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Yes, vaccinated yearly
No, and not planning to do so
No but will do as soon as possible
Don't have any other pets
Other animals at my home include...
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What type of dwelling will your new pet be living in?
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House
Townhouse WITH a yard
Townhouse WITHOUT a yard
Apartment
Acerage
Home situation?
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Own my own home
Renting, written permission from landlord for pets
Renting, waiting for written permission from landlord for a pet
Please describe your property fencing. Include height, material it's made from, and gates
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Where will your new pet be kept during the day and night? Inside, Outside, Both etc. Please give details
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How many hours a day will the animal be left alone?
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If a single pet home, would you consider adopting a second pet?
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If you were to move, what would you do with your animal?
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Do you plan on providing obedience training for the animal?
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If you go on holidays, who will take care of your animal?
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I am aware of the of veterinary costs and cost associated with care of an animal and I am able to afford them.
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Have you ever had to surrender or rehome a pet? If yes, please give details.
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Is everyone in your household in agreement about adopting a pet?
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Would you agree to a property inspection to assess suitability?
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Please tick to confirm the following: I understand that Safe Haven Animal Rescue Inc. reserves the right to decline any applicant if not deemed suitable for the animal. I state that I have never been convicted of animal cruelty and have no charges pending relating to any offence involving an animal.
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