Adoption form

Adoption Application

Type of Pet:*

Pet you are applying for:
(leave blank if you have not selected a specific pet yet)

About You

First Name: Last Name:

Phone number:

E-mail:

Mailing Address:

City: State: Zip Code:

Click here if your mailing address and physical address are different.

Are you over 18?

About your home

Household setting Do you live in a: Do you own or rent? What is your home's activity level?

Have you obtained approval from the landlord to have a pet? Yes No

Please provide your landlord's contact information: (100 chars left)

Do you have any other pets at home?

How many?

Tell us more! List any pets you have living or deceased. (Please include name, breed, age, altered, sex, UTD Vaccines, Heartworm, living/deceased) (450 chars left)

I authorize my vet to speak with a HAVA member for a reference check.

Vet name and contact info: (225 chars left)

Have you ever owned a pet in the past? Yes No

Please list all people living your household. (Include Name, Relationship, Gender, and Age) (500 chars left)

Does anyone in your household have allergies to animals?

Are all members of your family agreeable to adopting a pet?

References & Acknowledgements

Please list up to three personal references that can tell us how wonderful your home would be for a pet, and a way to contact them. (500 chars left)

Last question... How did you hear about us? We would like to know who to thank! (200 chars left)

I understand that HAVA is a non-profit organization whose main goal is to help bring people and pets together. I am willing to pay the adoption fee and understand that this will be applied to veterinary and rescue expenses.

By submitting this application electronically, I agree to the following:

I have completely read this questionnaire and comprehend it fully.
I certify that the above information I have given is accurate and truthful.
I authorize a HAVA member to verify any and all information in this application, including reference call checks and conducting an in-home visit inspection, to be able to approve my adoption application.
I agree to release and covenant to hold harmless HAVA and its members from any claims, damages, costs, or actions incurred because of the care or actions of the pet.
I accept full responsibility for the pet(s) actions at all times, and release HAVA from any liabilities or damages that may be incurred.
I acknowledge that HAVA cannot guarantee any animals against parasites, diseases, or destructive behavior
I agree that if I'm unable to keep my pet(s) anymore that I will return the pet(s) to HAVA and try to give HAVA a two-week period to try and find another suitable foster for the pet(s).

I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in the forfeiture of any HAVA pet adopted by me.

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