• The adoption process starts when you fill out this application.

  • Once you have completed the application, please call your veterinarian to give them authorization to release your pets medical/vaccine information to Heath's Haven Rescue.

  • Also, make sure to contact your references and let them know we will be contacting them. A timely response will keep the application process moving smoothly.

  • We will provide you with notification when we have received your application.

  • We will check all references listed on your application, please do not include family and spouses as a reference.

  • We require proof of vaccines for all pets in your household and proof of spay/neuter. (This is verified by contacting your veterinarian or we may ask you for documentation.)

  • Once your references have been checked, we will contact you for a home visit.

  • Once the home visit is complete we will set up a time for you to meet the dog you are interested in.

  • If you are approved, the two week trial period will begin. During the two week trial, HHR is responsible for any vet expenses, food, etc. and the dog legally still belongs to HHR. We will provide you will current vaccination records at this time.

  • Once the trial period is over and you have decided to adopt, you must mail your adoption donation of $150 to HHR.

  • Once we have received the adoption donation we will forward all medical records to you.

  • If you chose not to adopt, you must return the dog to HHR.

  • If any area is left incomplete on this application, it will not be processed.


Name *
Phone *
Is everyone in agreement with the decision to adopt an animal?
Does anyone in the household have allergies to dogs?
Do you have a fenced yard?
What type of home do you live in?
Do you:
If renting/leasing, are there pet restrictions?
If renting, we will contact your landlord to ask if animals are acceptable in your home. You will not be able to adopt until we receive positive confirmation.
Landlord's Phone Number:
Landlord's Phone Number:
Please list the types of animals in your home. Dogs, cats, iguanas, etc.
Please list the breeds of animals in your home. German shepherd, tabby, etc.
Please list the names of the animals in your home. Ex: Zoom, Phoenix, Pixel.
Please list the ages of the animals in your home.
Please list which animals have been altered.
Are these pets up to date on vaccines?
Do the other dogs in your home get along with other dogs?
Do you have a regular veterinarian?
Clinic/Dr. Phone Number
Clinic/Dr. Phone Number
Clinic/Dr. Address
Clinic/Dr. Address
May we contact your regular veterinarian for a reference?
Do you agree to a home visit?
Have you ever surrendered an animal?
Have you ever had an animal euthanized?
REFERENCES (Non-Family/Non-Spouse)
Please provide us with two.
Reference 1 Name (Non-Family/Non-Spouse):
Reference 1 Name (Non-Family/Non-Spouse):
Reference 1 Phone:
Reference 1 Phone:
Reference 2 Name (Non-Family/Non-Spouse):
Reference 2 Name (Non-Family/Non-Spouse):
Reference 2 Phone:
Reference 2 Phone:
I agree and understand that I may not be the only application being reviewed for this dog. I understand Heath’s Haven does not adopt on a “first come, first served” basis and all applicants are reviewed by the same process. We will base our decision on what we feel is the best fit for the dog *
I agree that the above described dog is being adopted by me solely as a pet for myself and/or my immediate family. If at any time, I am unable to care for the dog, I will notify Heath's Haven and I will not surrender the dog to a rescue or shelter without contacting Heath's Haven. I agree to to be legally and financially responsible for this dog and to provide all necessary veterinary treatment and routine vaccines for this dog. *
I agree to provide proof of vaccines for animals that are currently in my home. *
I agree to abide by all state and local animal control and leash laws. I understand it is my responsibility to become familiar with these laws and to license the dog according to all regulations. *
I agree to care for the dog in a humane and responsible manner and to provide him/her with clean and adequate shelter, food, water, and veterinary care. I will not cosmetically alter the dog by tail docking, ear cropping, piercings, etc. I further agree that this dog will reside inside my home and will not be allowed to roam freely. I will keep this dog in a secure, fenced environment while outdoors and a safe, secured area while indoors and unsupervised. *
I agree to notify Heath’s Haven immediately if this dog becomes lost or stolen. *
I agree to abide by all state and local animal control and leash laws. I understand it is my responsibility to become familiar with these laws and to license the dog according to all regulations. *
I agree that the adoption donation of $200 helps to cover this dogs spay/neuter, vaccines, dewormer, and other medical expenses inquired while at Heath’s Haven. It is not refundable after a trial period of 14 days. Once the trial period of two weeks is over, I will mail my adoption donation directly to Heath’s Haven. It is not refundable after a trial period of 14 days. *
I agree to allow the representatives of Heath’s Haven to review my adoption application, check my references, and perform a home visit. I understand a home visit is required in order to adopt a dog. *
I agree and understand that if transportation is needed for this dog, I am responsible for all transportation fees. I understand Heath’s Haven Rescue will do their best to plan, schedule, and arrange transport for this dog, but it is not Heath’s Haven’s sole responsibility to accommodate this part of the adoption. *
I agree that I have filled out the above form to the best of my ability and knowledge. If any information is found to be false, I understand it may result in my application being rejected and may result in the dog being removed from my home. *
I agree and understand that Heath’s Haven Rescue makes no representations or warranties, expressed or implied, about the above mentioned dog's temperament, and is absolved from any liability for future damages or injuries caused by the dog. I also understand and agree that Heath’s Haven further gives no guarantees, expressed or implied, of the suitability of the animal to the adopter and/or family. *