Adoption Application Please enable JavaScript in your browser to complete this form.Please enter the ID number of the animal you are interested in adopting. The Animal ID may be found on the social media post of the animal or on our website Adoption page. Are you 18 years of age or older? *YesNoName *FirstLastPhone *Email *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDo you rent or own your home? *RentOwnPets currently in your household: *Name and phone number of your current veterinarian:Have you ever been convicted of a felony? *YesNoIf yes, please explain.Are you willing to complete and pay for a background check? *YesNoThe cost of the background check is $25Are you currently fostering any animals for another rescue or shelter? *YesNoIf yes, provide the name of the rescue or shelter.How many people live in your household? What are their ages? *Do you have a backyard? Is it fenced and secured? Do you have a balcony? *What are your strengths that will make you a good pet parent? *How long are you away from home on average each day? *Less than 5 hours5-10 hoursMore than 10 hoursWhere would the animal be kept while you are away from home? *Does anyone in your household smoke indoors? *YesNoDoes anyone in your household have allergies to animals? *YesNoPlease list the names and phone numbers of two references. People who can attest to your responsibility, reliability and honesty. *If you wish to adopt an animal and already have another pet(s) at home, please confirm that your pet(s) is over 16 weeks, up to date on vaccines, and (for dogs) receiving heartworm and flea/tick prevention. Please note: if your resident pet(s) is not up to date on vaccines and not on heartworm and flea/tick preventation, you will not be approved to adopt. You may be asked to provide proof. *I confirm that my pet(s) are up-to-date on vaccines and are currently receiving heartworm and flea/tick prevention.I do not have other pets at home.Are the pets in your home spayed/neutered? *YesNoHaven may conduct a home visit to the adoptive family to ensure it is a safe environment for the animal. This may be done before you get your adopted pet, or at the time of receiving your pet. Do you agree to this home visit? *Yes, I agree.No, I do not agree.You consent to the rescue screening your adoption application, including some or all of the following: checking listed references; HOA/landlord/complex; and any searchable public record. *I consent.I have carefully read this Application and fully understand its contents. By entering my name below, I am signing this application and agreement. *NameDate *Submit