Adoption Application "*" indicates required fields Name (Please use legal name, you may state another name in the comments)* First Middle Initial Last Birthday* Email* Phone*Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Which cat/dog are you applying for?* Have you met the animal, and been informed of any special needs they may have?* Yes No Names of other adults living in the residence and their relationship to you? Include first & last names, as well as middle initial.* Note: Failing to list all adults living in the residence may automatically disqualify you.Do you agree to a background check for yourself and all other adults in the residence (if applicable)* Yes No Not all violations will disqualify you, if you have a criminal record and you would like to explain the situation, please do so here: Do you work full time or part time?* Full Time Part Time Retired/not working Employer Name:* Employer Phone:*Job Role:* What shift do you work?* 1st Shift 2nd Shift 3rd Shift Do you rent or own?* Rent Own How long have you been at your current residence?* If renting are you allowed to have pets?* Yes No If renting, please provide the property name, landlord's name and phone number.* Will you ever move to a place that does not allow pets?* Yes No If you ever move out of the city/state, will you take your pets with you?* Yes No Do you currently have any other pets?* Yes No If yes, please specify type, breed (for dogs), and age?* If no, do you have any other experience caring for animals? Please explain.* Are all of your pets fixed?* Yes No Are they up to date on their vaccinations?* Yes No Veterinarian name: Please list your veterinarian contact info for confirmationVeterinarian phone:Please list your veterinarian contact info for confirmationHave your pets been around other animals before?* Yes No N/A Are you prepared to gradually introduce your pets to the new animal and understand that there will be an adjustment period?* Yes No N/A Have you ever surrendered a pet?* Yes No If yes, why?* Do you have any children?* Yes No Please specify their ages.* Are you planning to declaw?* Yes No If claws are an issue in your home, what preventative measures will you take to keep them from scratching your furniture / belongings? (For cats) Are you prepared to have an adequate number of litter boxes and clean them DAILY to prevent the cat from urinating/defecating outside of the box?* Yes No N/A (For cats) Will the cat be kept indoors, outdoors, or both?* Indoors Outdoors Both N/A Are you aware of the lifespan of a pet (cats can live up to 20+ years!) and are you prepared to care for it that long?* Yes No Are you prepared to keep the pet in the event of a life change (including but not limited to: moving, having a baby, starting a new job, school etc.)* Yes No Are you aware of the financial obligations that come with adopting a pet (including but not limited to: Vaccines, yearly vet visits, medical care as needed, food, litter, toys etc.)?* Yes No How much are you willing/able to spend on your pets yearly?* < $500 $500 to $999 $1,000 to $1,999 $2,000 to $4,999 > $5,000 Do you tend to keep things that other people would get rid of?* Yes No If yes please explain.* Do you often collect free things or buy more things than you need or can use or can afford?* Yes No If yes please explain.* Do you experience stress due to clutter in your household?* Yes No If yes please explain.* How many hours will the pet be left alone during the day/night?* Do you travel often? Yes No What arrangements are made for your pets when you do travel? Why are you interested in adopting this specific cat/dog?*Please give us any other information that may be helpful or relevant in the consideration process.I understand that my application may take up to 2 weeks to process. I will check my email for a response, including spam.* Yes No *Thank you for your application! You will receive a status email within one-two weeks of receiving your application. Please remember to check your SPAM email folder as well. Applications will be handled in the order in which they were received. Thank you, Safe Haven Pet Sanctuary & Pawffee Shop Adoption Team*NameThis field is for validation purposes and should be left unchanged.
