Rescue Dog Adoption Application

Cane Haven Rescue is a non-profit, animal welfare organization dedicated to the rescue and placement of stray, neglected and abused animals. Cane Haven Rescue is completely funded through fundraising efforts and public donations. All of our pets are cared for by foster homes and receive complete medical care, which includes heart worm testing, vaccinations, spaying/neutering, microchipping, and starting on monthly prevention prior to their adoption. We will also send our dogs for obedience or behavioral training if it's needed.

This questionnaire is designed to help Cane Haven Rescue and yourself determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. Cane Haven Rescue reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions!

Name of the dog you are interested in: *

Your full name: *

Your age: *

Street Address: *

City, State, Zip *

Cell Phone: *

Area Code Phone Number

Work Phone:

Area Code Phone Number

E-mail: *

Employer:

Character reference and phone number:

Are all members of your household in agreement with this adoption? *

Yes No

Who will be the pet's primary caregiver? *

Do you live in a *

House Apartment Condo Mobile Home

Do you own or rent? *

Own Rent

If rent, provide name and phone number of landlord: *

Does your landlord allow dogs?

Yes No

Are there any restrictions from your landlord or subdivision? *

Number of pets Size or weight restrictions Breed restrictions None

Do you have a fully fenced yard? *

Yes No

Height and type of fence

Do you have any of the following?

Underground fence Kennel Dog Run Electric Fence

How many adults are in your household? *

How many children are in your household? *

If children, what are their ages?

Have your children been around animals before?

Yes No

Does anyone in your home have allergies to dogs or have asthma? *

Yes No

List any pets you own or have owned in the past five years, and their ages *

How many of these pets are spayed/neutered? *

What kind of heartworm and flea prevention is your pets currently on? *

Where are these animals now? *

Have you adopted from an animal welfare group before?

Yes No

If yes, what group?

Have you ever surrendered a pet? *

Yes No

If yes, what were the circumstances?

Please provide the name and phone number of your current and/or previous veterinarian or clinic: *

What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato) *

Are you aware of crate training? *

Yes No

Have you ever house-broken a dog or puppy before? *

Yes No

If the dog has an "accident" in your home, what type of correction do you plan to use? *

How many hours each day will your new pet be home alone? *

Where will your new pet sleep at night? *

How will you supervise the dog's outdoor activity? *

Where will your new dog stay when nobody is home? *

What length of time will you allow your new pet to adjust to his new home? *

Are you willing to work through your new pet's issues, if any? *

Yes No

Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior? *

Yes No

Are you aware that a large breed dog takes about two years to mature? Is this something you're prepared for? *

Yes No

What circumstances would lead you to give up your new dog? *

If you had to give up your dog, what would you do with him/her? *

How did you find out about Cane Haven Rescue? *

Facebook Friend/Family Member Other website

I understand that I assume full responsibility for the welfare of this pet from the date of adoption.

Name

First Name Last Name

Adoption Application

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information