First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County*

Email*

Home Phone

Work Phone
x

Cell Phone*

Alt Email

Please list ALL household members by name, relation, and AGE (including yourself). *Note: Adopter must be at least 25 years of age.*

Are there any special needs children in the home?*
Choose one: Yes No

Does anyone living in the home have pet allergies?*
Choose one: Yes No

Please list the occupation for each adult in the home.*

Do you own or rent your home?*
Choose one: Rent Own

If you rent, do you have the approval of your landlord to have an animal?*
Choose one: Yes No N/A

If you rent, please enter your landlord's name, phone number, and email address. (Your application will NOT be processed without this information).

What type of residence do you live in?*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing Assisted Living Ranch

What is the size of your home?*
Choose one: less than 1000 sq. ft 1000 - 1500 sq ft 1500 - 2000 sq ft 2000 - 3000 sq ft 3000 - 4000 sq ft More than 4000 sq ft

How long have you lived at the address above? If less than 1 year please provide your previous address. *

What type of fence do you have?

What is the height of your fence?*

What size is the fenced area of your yard?*
Choose one: Small Medium Large Extra Large

Do you have a doggie door? *
Choose one: Yes No

If no fence, how do you plan to exercise your dog?*

Please tell us about each of your current pets including type of animal, name, age, and any behavioral issues.*

Are all of your dogs and/or cats spayed/neutered?*
Choose one: Yes No

If you have a dog or cat that has not been spayed or neutered please explain why.

Are all dogs and cats residing in your home on heart worm preventative?

What type of heart worm preventative are you currently providing for your dog(s) and/or cat(s)?*

Please provide us with the veterinarian that has the most up-to-date records for your dog(s), including dogs deceased within 5 years. Please list the clinic or facility name, address, and phone number. By providing the following information you are granting us permission to contact your vet for a reference check. Applications without ALL information will NOT be processed.*

Please list all previous dogs and cats you have had as an adult (you were the primary caregiver and had financial responsibility for the animal). Please include the length of time you owned the pet and why you no longer have them. Include name and breed. Do not list current pets here.*

How much money do you anticipate spending on your dog or puppy in the first year? Please explain. *

Why are you interested in adopting a pet at this time?*

Please list the dog(s) that you are interested in with Allie's Haven. If there is not a specific dog we will contact you (after approval) to discuss the best fit for you. Please note that listing a specific dog(s) does not guarantee the dogs availability or fit for your home.

What age dog do you prefer?
Choose all that apply: Under 6 months 6-12 months 1-3 years 3-5 years 5-8 years 8-10 years 10+ years

What gender dog are you interested in adopting?*
Choose one: Male Female Either

Are there any dog behaviors that you ARE NOT willing to work with?

What traits are you looking for in your dog? *

Are you willing to adopt a dog with medical needs? *

Who in the household will be the primary caretaker? *

Where will your dog be kept on a daily basis when you are not home?*

How much time will your dog spend alone during the day?*

Where will your dog be kept when you are home?*

Where will your dog sleep?*

Will your dog be kept inside or outside?*
Choose one: Inside Only Outside Only Inside and Outside

What is the primary source of exercise for your dog? (dog park, daily walks, backyard, doggie daycare, etc.)*

Would you consider your home:*
Choose one: Extremely Active Somewhat Active Mostly Quiet Very Quiet

Have you ever adopted a rescue dog before?*
Choose one: Yes No

If needed, are you willing to take your dog to obedience training? *
Choose one: Yes No

Do you already have a trainer you use or plan to use? If so, who? How long have you used them as a trainer? *

If you are no longer able to care for the dog, what would you do?*

Have you ever given up a pet? If yes, please explain.*

Please tell us how you became familiar with Allie's Haven Animal Rescue.*
Choose one: Online Meet and Greet Special Event Previous Adopter Word of Mouth Friend

If you were referred to Allie's Haven by someone, please tell us who and how you are affiliated with that person.

Are you interested in being a volunteer for Allie's Haven? We operate solely by the assistance of volunteers. If interested, please select an area(s) of interest below.

I hereby agree to hold Allie's Haven Animal Rescue and its Board of Directors, Volunteers, Foster homes and any and all entities and/or legal agents harmless from any injury, damages or losses directly or indirectly by any Allie's Haven Animal Rescue adoptable pets. Potential adopter and others release Allie's Haven Animal Rescue from any liability, claims, suits, obligations, demand or causes of action, known or unknown, foreseen or unforeseen arising out of any persons that come in contact with any Allie's Haven Animal Rescue pets.*
Choose one: Agree