Name of Dog _________________________ Today’s Date _________________________
The Haven Animal Care Shelter
“May we, God helping us, be part of the answer, not part of the problem.” - Peter Marshall
Dr. Brenda & Joe Wilbanks (806) 763-0092
4501 N C.R. 1729 Lubbock, Texas 79403
Dog Adoption Application
Welcome to the Haven Animal Care Shelter’s Adoption Program. The following information is requested so that we can assist you in the selection of a new dog. In order to be considered as an adopter you must check the following: □ Be 21 years of age or older □ Have identification showing your present address □ Have the knowledge and consent of your landlord □ Be able and willing to spend the time and money necessary to provide medical treatment and proper care for a pet. Name of Applicant: Street Address: City: State: Zip: Home Phone #: Cell Phone #: E-mail address: Work Phone #: Place the name of the dog or describe in detail the type of dog you’re looking for: Would this be your first dog? What kinds of pets have you had in the past? □ NA □ NA
Which of these do you still have? (include age, sex, breed) Have they been spayed or neutered? □ Yes □ No □ Don’t know Are they current on vaccinations? □ Yes □ No □ Don’t know What happened to the animals you no longer have?
If you have pets, will they adjust to a new dog in the house? □ Yes □ No □ Don’t know Why do you want this dog? □ Companion □ Companion for other pet □ House pet □ Guard dog □ Hunting □ Personal Protection □ Other How many adults are in your household? How many children? Children’s ages: Does any member of your household have an allergy to dogs? Is someone home during the day? Who? How many hours each day will the dog be without human companionship? Explain: Which do you live in? □House □Apartment □Condo □Mobile Home □Other Do you own or rent your home? □Own □ Rent
If you rent, may we contact the owner to obtain permission for this dog to live in you home? □Yes □No Owner’s name and phone number? Do you have a completely fenced yard? □ Yes □ No What kind of fence? Height Is there a gate? Do you have a dog door? □ Yes □ No Are there times when the dog will be tied up? □ Yes □ No If yes, when? Do you have a pool? □ Yes □ No If yes, is there a fence around it? □ Yes □ No If your new dog/puppy is not housebroken, what method will you use to train it? Will you keep the animal up-to-date on vaccinations? □ Yes □ No Who is your current veterinarian? Location May we call this veterinarian? □ Yes □ No Would you be able and willing to exercise this dog on a regular basis? □ Yes □ No Where will the dog be kept during the day? Where will the dog be kept during the night? If you drive a pickup truck, would you allow the dog to ride freely in the back? □ Yes □ No If you go out of town, who will take care of the dog? If you must move, will you take the dog with you? □ Yes □ No How much are you willing to spend on medical expenses for your dog (per year)? □ up to $100.00 □ up to $500.00 □ up to $1000.00 □ whatever it takes Have you ever applied to adopt an animal from The Haven before? □ Yes □ No If yes, when? Have you brought animals to The Haven before? □ Yes □ No If yes, explain: Are you willing to have a representative from The Haven come to see where the dog will be living? □ Yes □ No Are you willing to take the responsibility for this dog for the next 10-15 years? □ Yes □ No What provisions will you make for the dog should you become unable to care for him/her? Comments by applicant:
All the above is true and I understand that the adoption application review may take some time, but I can contact the Haven at any time about my application status. Applications are approved for the best suited home for the animal, not on a first come first serve basis.
Optional Survey: Where did you find out about the Haven? □ Haven ACS website □ Petfinder.com □ Petsmart □ Friends or Family □ Other Did you see this dog on Petfinder.com/Haven website before coming out to the shelter? □ Yes □ No
OFFICE USE ONLY: □ A □D