Pre Adoption Form

Your Name:

Spouse's Name:

Address:

City State Zip

Phone:

Cell Phone

Occupation

Work Schedule

I live in a (if other explain)

Do you rent or own? (If renting we need a statement from your landlord

stating that you are permitted to have an animal.)

Previous Address: City State Zip

Are you planning to move in the next year?

Do you have a fenced yard? (If no how will you exercise your pet?)

How many children living in the home?

Ages

,Do you have any other pets? (If Yes) Are they spayed/neutered

Name of Veterinarian:

How many pets have you owned in the past 5 years?

(If any) What happened to them?

Name of the pet you are interested in?

Answer Yes or No to the following statements:

I am at least 18 years of age.

Iam stating that I am financially and physically able to care for this pet.

Proper food and veterinary care can be costly and I am able to meet these requirements.

I understand that if the information contained herein is found to be false, my application can be refused or said animal adopted shall be relinquished to "Sierra's Haven" without a refund of monies paid.

I understand that should I adopt from Sierra's Haven the adoption fee goes toward the cost of caring for all the rescued animals and that this fee is non-refundable.

Please supply 2 personal references :

Name:

Address: City State Zip

Phone

Relationship:

Name:

Address: City State Zip

Phone

Relationship:

Sierra's Haven

Pre-Adoption Form