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.

All adoption fees will be waived for financial need

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.

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