The Pet Haven & Animal Rescue, Inc.
ADOPTION
APPLICATION
This completed questionnaire will help us pick the very best dog/cat for
you, your family and your lifestyle. It is very important that we find
the correct home for every rescued animal in our program. Completing this questionnaire
will help us find out if the animal you are interested in will be best suited for your home, family and lifestyle. If there
is a certain animal you are interested in, please fill it in: __________________. If there is not a particular animal you
are interested in, we will do our best to find the perfect match for you and anyone else in your household.
Please fill out ALL of the information requested. In
most cases an incomplete application is not processed.
1.Name: _________________________________________Age__________
Date: __________
2. Address: ________________________________ City:
________________State: ____
ZIP: _______
3. How long at current
address: _______________________
4. Telephone number(s): Home: ( ) -
Work: ( )
-
E-Mail:
5. Married ____Single____
6. Employer_________________________________________________________________
Spouse? _________________________________________________________________
7. Occupation(s): ___________________________________________________________
8. Number and ages of
children living in household: _________________________________
9.
What type of area do you live in? City ___ Suburb ___ Rural ___
10.
What type of housing? Apt. ___ Condo ___ Duplex ___ House ___ Other ___
11.
Do you rent or own your home? ______________________________________________
12.
If you rent or lease, do you have permission from your landlord:
to own a dog? Yes
___ No ___
to own a cat? Yes
___ No ___
Name and phone number of landlord:__________________________
13.
a) What other dogs have you previously owned? ________________________________
_____________________________________________________________________
b) What happened to them? (Please list) _______________________________________
_____________________________________________________________________
14.
What other types of animals live in your home? _____________________________________
___________________________________________________________________________
15.
What do you know about this breed? __________________________________
___________________________________________________________________________
16.
How did you hear about our animals, and who referred you to us? _____________________
___________________________________________________________________________
17.
Do you have a preference to the sex of the dog? Male ___ Female ___ Don’t
Care ___
If so, why? _________________________________________________________________
Color preference?____________ Age preference?___________________Size preference?_______
18.
a) Do you have a fenced yard? Yes ___ No ___ Height of fence __________
b) Describe your fence (type, construction, etc) ___________________________________
c) If you don’t have a fence, where and how
will the dog be exercised and be allowed to
eliminate?
______________________________________________________________
19.
What member of the family will be taking the MAJOR responsibility of caring for this animal?
____________________________________________________________________________
20.
What are your plans and goals for this dog? _________________________________________
____________________________________________________________________________
21.
a) Have you ever trained a dog in obedience classes? Yes ___
No ___
b) Will you take your dog to an obedience class? Yes ___
No ___
22.
Will the dog live in the home? Yes ___ No ___
If not, where? ________________________________________________________________
23.
Where EXACTLY will the dog sleep at night and be kept when there is no one at home?
____________________________________________________________________________
____________________________________________________________________________
24.
Do you believe in dog crates? Yes ___ No ___
25.
What are the major activities, hobbies, or exercises you and your family most participate in?
____________________________________________________________________________
26.
If you move, what will you do with your dog? _______________________________________
____________________________________________________________________________
____________________________________________________________________________
27.
When you go on vacation, where will your dog go and who will care for it? _________________
____________________________________________________________________________
28.
Who is the veterinarian that you have or would use? Please provide all
information:
Name: ______________________________________
Address: _______________________________________________
Phone: ________________________
29.
How will your dog travel to the Vet or other places? (In a car, van, back of a pickup truck, etc)
____________________________________________________________________________
30.
Do you mind if we call your Vet and ask how you take care of your animals? Yes
___ No ___
If yes, why? __________________________________________________________________
31.
Are you willing to allow a TPHAR, Inc. representative to periodically visit your home?
Yes ____ No ____ If no,
why? ________________________________________________
32.
Please list the names, addresses, and phone numbers of two (2) personal references (not related)
that you have known for at least two (2) years:
1. ____________________________________________________
____________________________________________________
2. ____________________________________________________
____________________________________________________
33.
Please tell us a little about yourself and why you feel you could provide a good home for a rescue
dog: ________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
34. Are you aware of the yearly costs
of maintaining a healthy dog? Yes_____ No______
35. Are you aware that there is an
adoption fee to help cover the costs of spay/neuter, vaccines, etc? Yes____ No____
36. What do you expect your annual
expenses to be for this pet? _______________
37. How would you encourage, reinforce
your dog's appropriate (good) behavior?_____________________________
_________________________________________________________________________________________
38. How would you prevent, manage
your dog's inappropriate (not so good) behavior?__________________________
_________________________________________________________________________________________
39. How many hours will the dog be
left alone per day?__________
40.Why do you want to adopt a pet?
_________________________________________________________________________________________
41. Do you or anyone in your home smoke?____________
42. Have you ever owned a pet like this before?___________
43. Do you know many of the dogs in rescue programs have been neglected/abused by their former owners? Y______N______
44. Do you realize that dog ownership is a commitment for the natural life of the dog? This dog will never be resold
or given away, but returned to TPHAR Inc., should the owner no longer be able to keep it. Y____N____
_____________________________________________
(signature of applicant)
WE RESERVE THE RIGHT TO
REFUSE ANY APPLICANT
Complete and return to: The Pet Haven & Animal Rescue, Inc.
Fax:
850-422-3638
Email: pethavenanimalrescue@yahoo.com
