Lake Haven Online Pet Adoption Application

 

Online Application Instructions: Please fill out the application below.  Only those applications that are completely filled out are able to be processed.  If you would like to see the terms of the application again, please click here.

___________________________

Name of pet you are interested in adopting:

Please provide the following contact information:

First Name:   Last Name:  

Street Address:   

City: State: Zip:

Work Phone: Home Phone:  

Email Address:

 

Please list all people living in the household…  include names, ages and relationship to applicant.:

___________________________

Do you own your current home?
Yes
No
 

              

What type of home are currently living in?  (Note - living in an apartment, mobile home or condo WILL NOT disqualify you from adopting a pet as long as you are available to meet that pet's individual needs.)
House
Apartment

Condo

Mobile home

IF RENTING, please describe any restrictions on pets... size, breed, (declawed) cats, etc.

 

___________________________

 

If you are applying to adopt a dog, how will the dog be let out to relieve itself?                                                             Select any of the following options that apply:

        

        fenced yard

        Yes No

 

        leash walked

        Yes No

        

        free roam

        Yes No

 

        tie out cable

        Yes No

 

        kennel run

        Yes No

 

        loose with supervision

        Yes No

 

        Other (if yes, please explain)

        Yes No

 

IF "OTHER" above, please explain.

___________________________

 

Are you currently employed?
Yes
No

IF YES, list your current employer and how many years you have been employed.

___________________________

Where will your new pet stay when you are away?

How many hours a day do you anticipate your pet being home alone?

Where will your new pet sleep at night?

If you are applying for a dog or puppy, are you familiar with crate training?  Do you intend to use a crate?                           Do you currently have one?

     

If you are applying for a cat, will the cat be allowed outdoors?
Never
Yes

Overnight

As it wishes

___________________________

Please list all pets currently living in your home.  Include name, breed, age, and how long you have had them.

Please list all pets you have previously owned.  Include name, breed, and why you no longer have them.

 

Are your current pets spayed/neutered?
Yes
No

 

Are your present pets current on vaccinations?
Yes
No

If you currently have dogs, have they been heartworm tested?
Yes
No

If you currently have dogs, are they on heartworm prevention?
Yes
No

If your answer to the previous questions for any of your current pets was "No", please explain.

___________________________

 

Please provide the following veterinarian information.  (REQUIRED: Make sure you have contacted your current vet and requested a "release of information" to Lake Haven before submitting this application.  This authorizes your vet to talk to us.  We are unable to process applications without speaking to your current or most recent vet.)

Veterinarian's Name:  

Hospital/Clinic Name:

Street Address:  

City: State: Zip:

Phone: Fax:  

 

If you have used any other veterinarian, please list names and phone numbers below.  Include which pets they treated.

 ___________________________

Please share additional comments or considerations that you would like us to know: