The Haven for Dogs, Inc. Adoption Form

THE HAVEN FOR DOGS, INC.

Mail Completed Form To:
The Haven for Dogs, Inc.
P.O. Box 22505
Lexington, KY 40522-2505

Preliminary Adoption Form for Dogs
Name: ________________________ Address:_______________________ City/State:_________________ Zip: _______	Home Phone:___________________ Work Phone:___________________ Date of application:_____________________
1. What type of dog are you looking for? Please list any specific physical features that are important to you (gender, age, size, type of hair). 2. Do you prefer a: ___ High-activity, very playful dog ___ Moderately active, calmer dog ___ Mellow, lay-around dog
3. Are you adopting for: ___ Yourself, only ___ Friend/Relative	___ Immediate family ___ Business ___ Other (Please explain)
4. Please check any of these reasons for adopting. ___ Family pet ___ If Child's Pet Age(s) of Children: ________________________ ___ Adult Companion ___ Gift ___ Watch Dog (Bark Only)	___ Guard Dog (Will Bite) ___ Hunting ___ Obedience Training/Showing ___ Companion for Another Pet ___ Working-Doing What ___________________________ Other ______________________ ___________________________
5. If you currently own pets other than dogs, please list the species, and if they are spayed/neutered and vaccinated (if applicable)
6. Please check applicable living situations.
___ Own House ___ Rent House ___ Rent Duplex ___ Own Condo/Townhouse ___ Rent Apt/Condo/Townhouse ___ Own Mobile Home	___ Own Mobile Home Lot ___ Rent Mobile Home ___ Rent Mobile Home Lot ___ Parent/Guardian Home ___ Roommate's Home ___ Other __________________
7. If you rent, list the name of your apt/condo and landlord's name & phone number:
8. Where will the dog stay while owners are gone during work or school hours each day?
___ In Fenced Yard ___ Outside in Pen/Kennel ___ Outside-Unconfined ___ Tied or Fastened on Run ___ In Barn/Outside Building	___ In Garage ___ Crated ___ Loose in Home ___ Confined in Home ___ Other __________________
9. Where will the dog sleep at night? ___ Free run inside of home ___ In bed with owner ___ Crate ___ Confined to one room	___ Outside unconfined ___ Outside in fenced yard ___ Barn/outside building ___ Garage ___ Other __________________
10. Is your yard fenced*: ___ Totally ___ Partially ___ Not at all
*If fenced, Please note type of fence: __________________________________________________ 11. Does anyone in the household have allergies to dogs? ___ Yes ___ No

12. Please list particulars of dogs now owned, or owned in the past 5 years:
	Most Current	2nd	3rd	4th
What Breed?
Male/Female
Spayed/Neutered
Current Age
Age When Acquired
Age When Last Owned
What Happened If No Longer Owned
Up to Date on Vaccinations?
Healthy?
List Pet's Veterinarian
Behavior Problems with This Pet?

13. How much would you plan to spend on this pet each year (including food, extras, and vet care)?

___ $75 - $200 ___ $201 - $400 ___ Over $400

14a. During the work week, how many hours per day will the dog be alone (at home without owners? _____________________
14b. How many hours per day will the dog be alone on weekends or days off? _____________________

15. What problem(s) would constitute reason to give up your pet?

16. If you had to give up your pet for any reason, would you:

___ Give it away

___ Take it to the nearest shelter

___ Return it to The Haven

___ Sell it

17. Would you object to our verifying any of the preceding information? ___ Yes ___ No

18. Would you object to a visit to your home prior to adoption by an authorized representative of The Haven for Dogs, Inc.? ___ Yes ___ No

19. Would you object to a follow-up visit by an authorized representative of The Haven? ___ Yes ___ No

Thank you very much for filling out this questionnaire. It is not our intention to invade your privacy. Our purpose is to find a caring, responsible and permanent home for our animals. At the same time, we want to find a suitable pet for your to love and enjoy for many years.

Signature ___________________________________________ Date ___________________________________

This adoption application will remain the property of The Haven for Dogs, Inc.

Mail Completed Form To:
The Haven for Dogs, Inc.
P.O. Box 22505
Lexington, KY 40522-2505