Lake Haven | Adoption Form

Application Intent

Why are you filling out this application? I would like to meet a pet for POTENTIAL adoption
I'm ready to COMMIT to a pet

Name of pet you're interested in:

Your Contact Information

First Name: Last Name:
Street Address: City:
State: Zip:
Home Phone: Work_Phone: Email:

Note: Please double check your email address for accuracy. We will use this address to reply to you. If you mistype the address, you will not receive our reply. Please, only one email per line.

Housing Accommodations

List all people living in household, include names, ages and relationship to applicant.

Do you own your home?: Yes No

Type of home currently living in: House Condo Apartment Mobile Home

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.

IF RENTING, describe any restrictions or rules on pets:

Number of Years Renting:

Employment Information

Are you currently employed?: Yes No
Employer Name:

Years employed there:

Pet Accommodations

Where will pet sleep at night?

Where will pet stay when you are away?

Hours a day left alone:

If You're Applying for Dog or Puppy

How will the dog be let out to relieve itself (Select all that apply)? Fenced Yard
Leash Walk
Free Roam
Tie Out Cable
Kennel Run
Loose With Supervision
Other

IF OTHER, please explain:

Are familiar with crate training? Yes No

Do you intend to use a crate? Yes No

Do you currently have a crate? Yes No

If You're Applying for Cat

Will cat be allowed outside? Yes Never Overnight If it wishes

Current & Previous Pets

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 fixed? Yes No

Are your pets current on vaccinations? Yes No

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

If any of the 3 question above were "No", please explain in the space below.

Veterinarian Information

Do you have a veterinarian? Yes No

If you have a veterinarian then check the drop-down list below to see if your vet is one of our partners.

Our vet partners:

If your vet is not listed in the drop-down list above then please provide the following information about your vet:

Clinic Name: Clinic Phone:
City: State:

Final Comment

If you have any final comments that you would like to make about this application please do so in the space below: