This form must be filled out entirely and signed* before an adoption can be finalized.
(* If submitted by email, the typed name at the end is accepted by both parties as legal signature)
Please be very sure to complete each question!

Which pet (name) or type of pet (species, breed, age, size, sex, etc.) are you interested in?

What are your reasons for wanting a pet? (Please check all that may apply.)
Companionship      To grow with children     Guard dog      Hiking/running partner  
Children want a pet       Significant other wants pet       Present for other person
Friends have pets    Other:

Are there children at home?  Yes No

If yes, how many and what are their ages?

What are the age ranges and number of adults in the home?
20 to 30 30 to 40 40 to 50 50 to 60 Over 60

Do you frequently have children visiting your home (i.e. grandchildren)?  Yes No
If yes, what are their ages:

Do you own your own home or rent?  Own Rent
(Note: If you own your own home, please bring a copy of your mortgage payment or taxes at the time of the adoption.)

If you rent, do you have written permission from the landlord to have a pet? Yes No
(Note: You will need to provide a signed letter at the time of adoption.)

Landlord name and telephone:

Please list all pets you have owned in the last ten years, and where they are now (if deceased, state cause):

If you have not owned any pets in the last ten years, please explain why you have decided to adopt now:

Do you have other pets at home now? Yes No

# of dogs    # of cats    # of other

What breed is the other dog(s)?

Who will be assuming the main responsibility for this pet?

Have you ever had to give up a pet? Yes No

Please tell us about it in detail:

What circumstances might cause you to find a new home for your pet?
(example: moving, aggression, behavior, new baby, etc.):

Do you, or anyone in your family, have allergies?     Yes No
If so, to what?

What is your work schedule?

How much company will the pet have during the day?

Where will this pet be kept when someone is home (please check all that may apply):
Loose in house Outside kennel Crate in house Basement
Garage Loose outside Fenced yard Dog run Dog house
Other (please specify):

Do you have a fenced yard or area? Yes No

If yes, how big is the area (approximately):

Where will this pet be kept when no one is home? (Please check all that may apply.)
Loose in house Outside kennel Crate in house Basement
Garage Loose outside Fenced yard Dog run Dog house
Other (please specify):

Would you consider this pet to be an inside pet or an outside pet :

How will this pet be put outside to relieve himself, and how often?

Where will this pet sleep?

Where will this pet eat?

How do you plan to make sure your pet gets the exercise he needs? (Please be specific)

Do you plan on grooming this pet yourself? Yes No
Or hire a professional groomer? Yes No

Have you ever used a groomer for any other pets? Yes No
If yes, please list name and telephone number:

Have you ever used a crate for your pet? Yes No  
If yes, how and why did you use it:

Do you plan on using a crate with this dog? Yes No  
If yes, what is the maximum amount of hours the dog will be in the crate, how often, and why?

Have you ever taken a pet to obedience training? Yes No
If yes, which pet, where and when?

If you currently have a pet, is it neutered/spayed? Yes No

Have you neutered/spayed the other pets you've owned? Yes No

Have any of your pets ever had a litter? Yes No
If yes, what did you do with the kittens or puppies?

Is your current pet on heartworm prevention? Yes No

Were your past pets on heartworm prevention? Yes No

Approximately how much do you plan on spending per year on your dog for veterinary care, food, grooming, and all his needs?

Do you have a vet now? Yes No

Vets Name:
Town, State:
Telephone #:
What name is the account under?

Have you used any other vets in the past? Yes No
Vets Name:
Town, State:
Telephone #:
What name is the account under?
(Please note: Veterinary references are extremely important - do not skip this part unless you have never used a vet!)

Please list two personal references:
Name:
Relationship to you:
Phone Number:

Name:
Relationship to you:
Phone Number:

How do you feel about grooming?
Enjoy very much         Tolerate - once a week brushing      No brushing/bathing

How do you feel about activity level (You may choose only one):
Very active dog, possible agility candidate     
Hiking/running partner, needs long walks once or twice a day
Likes to go on casual walks, once a day or every couple days     
Enjoys hanging around the house/yard, watching TV or just dozing and cuddling

How do you feel about...
Pets jumping up on you and your guests?
Muddy pawprints throughout house?
Pets up on furniture?
Pets sleeping on beds with people?
Professional obedience training?

Please describe the perfect pet for you. Be as detailed as possible.
(Remember, we know these pets very well and want to work with you to find the right pet for you):

Can you think of anything else that might help us decide if this pet, or which pet, would be right for you at this time?

Terms of Adoption:
My signature below indicates that I am at least 21 years of age and intend to be the legal owner and the person responsible for the care and well being of any pet I adopt from Ahimsa Haven, Inc. By signing this application, I give representatives of Ahimsa Haven, Inc. permission to contact my veterinarian, landlord, personal references, or other rescue groups/humane societies for information to aid in the evaluation of whether this pet is appropriate for me.   I also give them permission to visit my home either before or after the adoption (or both) unannounced for purposes of checking to see if this pet is being treated according to this adoption agreement and in a humane manner.  I understand that any misrepresentation of the true facts in this application will invalidate the adoption agreement and give Ahimsa Haven, Inc. the right to reclaim the pet without refund of the adoption fee.

Cost:
Adoption fees are listed below and help to cover our cost of spaying/neutering, vaccinations, worming, and the care and feeding of dogs in our care.
Puppies less than one year:  $350 to $400 depending on breed and age (please ask prior to adoption).
Dogs less than 5 years old:  $250-300 depending on breed and age (please ask prior to adoption).
Dogs over 6 years old:  $150 (please ask prior to adoption).
Adoption fees must be paid in full at the time of adoption.  NO EXCEPTIONS.  We accept cash, money order, or personal check.
Note: there are special circumstances (i.e. rare breeds, illness, disability, etc.) where these fees could be raised, or drastically reduced.  If you feel that the dog you are adopting might be considered a special circumstances dog, please don't hesitate to discuss the fee with us.  Our goal is to find all dogs a loving forever home.

Medical:
I understand that this pet has been given certain basic inoculations and other medical treatment for problems that Ahimsa Haven, Inc. is aware of and can treat before adoption. The pet I am adopting is accepted by me "as is." I agree to provide yearly checkups, vaccines, and heartworm prevention as well as treatment for emergencies.  I understand that Ahimsa Haven, Inc. makes no representations or warranties regarding the current or future medical condition of the pet and is not responsible for additional medical care for the pet. While most pets are provided neutered state law requires that intact adopted pets have a $30 neuter deposit which will be returned to me when I neuter this pet within 60 days.  I understand that if I do not spay or neuter this pet, that Ahimsa Haven has the right to take this pet from me and this application and/or adoption agreement is rendered invalid.

Temperament:
I understand that this pet may have not been temperament tested and/or evaluated professionally, and that Ahimsa Haven, Inc. makes no representations or warranties regarding the pets behavior with adults, children, or other animals, or provide other guarantees as to the pets characteristics, personality, or training. I understand and agree that Ahimsa Haven, Inc. and/or any of its representatives are not responsible for any injuries or property damage resulting from the possession or ownership of this pet.

Care:
As this pet's new owner, I agree to provide the training required to ensure a secure and respectful pet/owner relationship. I will not let the pet run free without supervision, be chained out all day or all night, be around children under 14 years of age without adult supervision, ride loose in the back of an open truck, or remain unattended in any vehicle when the temperature is over 70 degrees Fahrenheit.  I will see that this pet has the physical exercise and the mental stimulation it needs to insure a physically and mentally healthy animal.  I will license the pet in the town I live in and tag the pet for identification purposes.  I will provide fresh clean water at all times, and will feed the pet a minimum of twice daily the appropriate fresh and healthy food. 

Adoption Termination:
I understand that if, for any reason, the adoption is not satisfactory for the pet or adoptive owner Ahimsa Haven, Inc. requires that the pet be returned to Ahimsa Haven, Inc. even if that date is many years in the future.  If the pet is returned within one month by the adoptive owner the adoption fee will be refunded in full.  Ahimsa Haven, Inc. asks that pets be kept a minimum of 48 hours if possible to allow both pet and owner the time necessary to adjust to their new living situation. The pet may not be sold or given to a new owner without Ahimsa Haven, Inc.'s prior written approval.  If the pet is given/sold to other person(s), I will pay a fine of not less than $500 to Ahimsa Haven on written request.  Ahimsa Haven Inc. reserves the right to take back this pet if it is ever neglected, abused, or improperly cared for including lack of veterinary care, and I agree to relinquish custody immediately upon request without the need for further legal writ or court order. I agree to promptly contact Ahimsa Haven, Inc. if the pet is lost for more than 24 hours.

I, on behalf of myself and all persons resident in the household where [pets name] will reside, hereby accept possession of title to [pets name] and responsibility for the animal identified above and hereby release, indemnify and discharge Ahimsa Haven, Inc., and its officers, employees and agents, forever from and against any liability for any injury or damage to any person or property caused in the future by this adoption, or by said pet, and from and against any causes of actions, suits or demands whatsoever that may arise as a result of such injury or damage.