ADOPTION APPLICATION

Safe Haven Pre-Adoption Form

*All fields must be filled in. Incomplete forms will not be processed.

The SAFE HAVEN Humane Society appreciates your concern for homeless animals. We respectfully request that you complete this Pre-Adoption Application so that we can assist you in finding a suitable companion pet. SAFE HAVEN respects and strictly adheres to the regulations set forth by the Illinois Animal Welfare Act, which specifically stipulates that any adopted animal must be spayed or neutered. A new pet must also be properly inoculated with special attention to rabies. I understand that SAFE HAVEN must approve of my ability to be an adoptive family for a SAFE HAVEN companion pet. An adopted animal must be examined by a veterinarian within 7 days following adoption.

If you are 18 years of age or older and have a valid ID showing your current address, you may complete the following:

 

First Name*

Last Name*

Co-Applicant’s

First Name*

Last Name*

Address*

City*

State*

Zip*

Main Phone Number*  

Secondary Phone Number

Email*

We will send an email to this address when we receive your application during our regular business hours Mon – Sat, 10am to 3pm.

Place of Work

Work City

Work Phone

I go to
Work
School
Stay At Home
Other

Name of pet I'm applying for?

Healthy animals can live up to 12-15+ years. Are you willing to dedicate that lifetime to a new pet?
Yes
No

What would happen to the pet if something happened to you?

Why this specific pet? What attracts you to them? If not applying for a specific pet, put N/A

I live in a
House
Condo
Mobile Home
Apartment
Dorm

# Adults in home?

# Kids in home?

Kids ages?

Is the whole family in agreement to adopt a pet?
Yes
No

Describe Household
Active
Noisy
Quiet
Other-Explain

Explain

Who will feed the new pet?

Train it

Why do you want a new pet?

If you rent your residence please give

Landlord Name

Landlord Phone

Tell us about the other pets you owned IN THE PAST 5 YEARS including breed, where kept, oldest age, sex, neutered, still owned and where it is now

Other pets?

Please list your past and current vets name, address and phone number

We will contact your vet. Please provide the name of the person on file for your pet if different than yours.

Does anyone in your family have allergies to pets?
Yes
No

Where will you keep your new pet?
House
Basement
Outdoors
Yard
Pen
Crate

How many hours per day will your pet be left alone?

How many days per week?

If you move, what will happen to your pet?
Take with
Find another home

How much time are you prepared to allow for your new pet to adjust to your home?

Are you able to afford a bill of $200-$800 or more for emergency vet care?
Yes
No

Dog Questions

Do you want
Adult Dog
Puppy
No preference

Do you have a fenced in yard?
yes
no

Who will walk your new dog on leash?

How often?

Dogs often get away from their owners. What ID will you put on your new dog?

Potential problems such as excessive barking, chewing, digging, housebreaking, and/or aggressive behavior may require obedience classes. Are you willing to spend the time and money to correct such behavior?
Yes
No

Cat Questions

Do you want
Adult cat
Kitten
No Preference

Will your new cat be living?
Indoors
Outdoors
Indoors/Outdoors

Most cats jump on tables, kitchen counters and furniture. How would you correct this behavior?

Cats may scratch the furniture and carpet. Do you plan to trim front claws, buy a scratching post, or declaw?

How did you learn about Safe Haven?
Adoption fair
Newspaper ad
Website
Other

Name, address, and phone number of two personal references that are not related to you. Please notify your references that we will be calling them.

Name*

Address*

Phone*  

Name*

Address*

Phone*  

Any additional comments or questions regarding your application

By submitting this form electronically, I hereby certify that the information I have provided is true and that any misrepresentation may result in my losing the privilege of adopting a pet from SAFE HAVEN. I authorize SAFE HAVEN to confirm any of the information I have provided and understand that SAFE HAVEN has the authority to deny a pet adoption.

Verification Code