Our Adoption Application: Name * First Name Last Name Name of the dog you are interested in: Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email Occupation: Name Of Employer: Employer Address: Employer Phone Number: (###) ### #### Place Of Residence? Do You Rent? If You Do Rent, What Is The Name Of Your Landlord? Landlord's Phone Number: (###) ### #### How Long Have You Lived At This Address? Do You Have a Swimming Pool? Is The Pool Fenced In? Is Your Home Air Conditioned? Is Your Car Air Conditioned? Is Your Home Fenced Securely For a Dog? Describe Your Fence: If You Move In the Future, Will it Be to A Dog Friendly Home? Do You Have Any Children? If Yes, list their names and ages: If Yes, Will They Be Supervised Around The Dog? Is Any Member Of The Family Allergic To Dogs? How Many Adults Live In The House? Who Will Have Responsibility For The Dog? If Yes, What Are Their Disabilities? Is There Anyone In The Home With Disabilities? Do You Have Any Additional Pets? If Yes, Please List What, And Their Ages: Are They Spayed and Neutered? Is Someone Home During The Day? Will You Allow Raiden's Haven To Do A Home Inspection? Have You Ever Owned A Dog Before? Have You Educated Yourself On Their Needs? Do You Have A Gender Preference? Do You Have An Age Preference? Would You Consider A Senior (7+)? Would You Consider A Dog With Health Issues? Would You Consider A Dog That Has Been Neglected Or Abused? Would You Consider A Dog That Has Anxiety? Would You Consider A Dog That Is Not House Trained? Would You Consider A Dog That Has Special Dietary Needs? Would You Consider A Bonded Pair? What Behaviors Do You Feel You Are Not Willing To Adopt For? How Many Hours A Day Will The Dog Be Alone? Where Will Your Dog Be Kept When No One Is Home? Are You Financially Able To Care For A Dog? How Many Miles Are You Willing To Drive To Pick Up Your Adopted Dog? What Will You Do With Your Dog When You Go On Vacation? Have You Ever Had A Pet Euthanized? If Yes, Please Explain: Have You Ever Brought A Pet To A Shelter? If Yes, Please Explain: Name Of Your Veterinarian? Address And Phone Number Of Your Veterinarian? Personal Reference 1 Name And Phone Number: Relationship (non-household members): Personal Reference 2 Name And Phone Number: Relationship (non-household members): Do You Object To A Raiden's Haven Volunteer Checking In Periodically? Checkbox If The Following Is True: I represent that the information I have provided on this application is accurate to the best of my knowledge. Thank you!
