Adoption Application

Safe Haven Pre-Adoption Form

*All fields must be filled in. Incomplete forms will not be processed.

The SAFE HAVEN Humane Society appreciates your concern for homeless animals. We respectfully request that you complete this Pre-Adoption Application so that we can assist you in finding a suitable companion pet. SAFE HAVEN respects and strictly adheres to the regulations set forth by the Illinois Animal Welfare Act, which specifically stipulates that any adopted animal must be spayed or neutered. A new pet must also be properly inoculated with special attention to rabies. I understand that SAFE HAVEN must approve of my ability to be an adoptive family for a SAFE HAVEN companion pet. An adopted animal must be examined by a veterinarian within 7 days following adoption.

If you are 18 years of age or older and have a valid ID showing your current address, you may complete the following:

* Name:
* Address:
* City, State, Zip:
* Phone:
Cell Phone:
* Email:
Place of Work:
Work City:
Work Phone:
I go to:
Stay At Home
Name of Pet I Am Applying For

I Live In A:
Mobile Home
# Adults In Home
# Kids In Home
Kids Ages
Who Will Feed the New Pet?
Train It
Why Do You Want A New Pet
If You Rent Your Residence Please Give:

Landlord Name

Landlord Phone

Tell us about the Other Pets you owned IN THE PAST 5 YEARS including breed, where kept, oldest age, sex, neutered, still owned and where it is now:

Other Pets
Please List Your New Vets Name Address and Phone Number
Does Anyone In Your Family Have Allergies? Please List Whom and What
Where Will You Keep Your New Pet:
How Many Hours Per Day Will Your Pet Be Left Alone
If you move, what will happen to your pet
Take with
Find another home

Dog Questions

Do You Want
Adult Dog
Do You Have A Fenced In Yard
Who will walk your new dog on leash
How Often
What ID will you put on new dog

Potential problems such as excessive barking, chewing, digging, housebreaking, and/or aggressive behavior may require obedience classes. Are you willing to spend the time and money to correct such behavior?

I Am Willing

Cat Questions

Do You Want
adult cat
Will Your New Cat Be Living
Most cats jump on tables, kitchen counters and furniture. How would you correct this behavior?
Cats may scratch the furniture and carpet. Do you plan to trim front claws, buy a scratching post, or declaw?

How Did You Learn About Safe Haven
adoption fair
newspaper ad

Name, Address and Phone Number Of Two References

By submitting this form electronically, I hereby certify that the information I have provided is true and that any misrepresentation may result in my losing the privilege of adopting a pet from SAFE HAVEN. I authorize SAFE HAVEN to confirm any of the information I have provided and understand that SAFE HAVEN has the authority to deny a pet adoption.

Verification Code