Adoption Application

Please read this first. Occasionally, potential adopters provide foster care for a rescue dog before the adoption is finalized. This gives everyone time to see if the dog is a good match for the family. Due to this, we ask that you complete all sections of this application, even if you don't plan to become a regular volunteer for Havanese Rescue. Thank you! If you are interested in volunteering with HRI, please register as a volunteer. NOTE: You will be asked to provide the names and phone numbers for FOUR personal references and one veterinary reference. Please collect that information prior to beginning the application.

Residence Location

Select State(*)

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IMPORTANT! Please select your state of residence (or Canada - at bottom) from this drop-down list. Failure to do so WILL delay the processing of your application.

Your First Name(*)

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Your Last Name(*)

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Your Age(*)

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You must be 18 years of age or older to adopt a dog.

Your Email(*)

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Repeat your email again(*)

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Application Type(*)

Adoption OnlyFoster To Adopt

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Tell us if you would consider fostering prior to adoption, or if you are interested in only adoption.

Name of specific dog

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If you are interested in a specific dog for adoption please enter the dog's name from our website here.

Do you have a preference regarding the age of the dog?

Address Information

Address

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Address line 2

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City

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State or Province

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Phone Number

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Household Member Please provide the following information for each person, other than the applicant above, who will be living in the household with the dog, starting with the spouse or significant other. Use the freqent visitors space if you have more than four family members.

Spouse of Significant Other

Spouse or Significant Other Name

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Spouse or Significant Other Age

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Spouse or Significant Other Relationship

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Family Member 2

Family Member 2 Name

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Family Member 2 Age

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Family Member 2 Relationship

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Family Member 3

Family Member 3 Name

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Family Member 3 Age

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Family Member 3 Relationship

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Family Member 4

Family Member 4 Name

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Family Member 4 Age

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Family Member 4 Relationship

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Other Visitors

Name Visitors

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Please provide relevant information on other regular/frequent visitors to the home, including grandchildren, neices/nephews, eldery/disabled people, etc.

Residence Details

Select Dwelling Type

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Do you rent of own?

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Landlord Name/Address (if applicable)

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Landlord Phone Number with Area Code

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Do you have plans to move in the near future? If yes, please elaborate.

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Do you have a pool? If yes, describe how the dog will be protected from drowning.

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Do you currently have a fenced yard? Please explain what type and how high.

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If you indicated that you do not have a fence, how do you plan to handle exercise and toilet duties? Please explain in detail.

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Personal References Please provide four (4) references (usually, only three (3) will be contacted), only ONE of which may be a relative, who are familiar with your home and pets. You must include a phone number for each reference. An email contact would be very helpful.

Reference 1

Reference 1 Name

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Reference 1 Relationship

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Reference 1 Phone Number

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Reference 2

Reference 2 Name

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Reference 2 Relationship

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Reference 2 Phone Number

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Reference 3

Reference 3 Name

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Reference 3 Relationship

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Reference 3 Phone Number

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Reference 4

Reference 4 Name

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Reference 4 Relationship

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Reference 4 Phone Number

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Veterinary Reference Please provide a veterinary reference who can confirm vaccination and heart worm testing records for your current pet(s). If you do not have any pets currently, please provide the name of a vet who cared for your pet(s) within the last five (5) years. Even if another member of your household owned the pet(s), veterinarian information must be provided.

Vet Name

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Clinic Name

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Clinic Address

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Clinic City

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Clinic State

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Clinic Zip Code

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Vet/Clinic Phone Number

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Please explain if this is not your regular veterinaran.

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Dog Care and Guardianship

Why do you want to adopt a Havanese?

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Would you be willing to adopt a Havanese mix? If no, please explain why.

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Is everyone in the household committed to adopting a Havanese? If no, please explain.

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Would you adopt a dog with temperament issues? Please indicate any behavior you would NOT be comfortable dealing with.

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Please explain if you have a preference for a male or female only.

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Are you willing to work through any house training adjustments? Please explain.

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Who will be the primary caregiver for the adopted dog?

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Have you ever fostered or adopted a rescue dog before? If yes, please provide the name of the shelter/rescue group.

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Are you willing to provide medical treatment to the dog? Check all that apply.

Monthly Heartworm Medication

Monthly Flea/Tick preventative (if recommended in your area)

Daily medication for various issues

Injections (for diabetes, etc.)

IV fluids (for kidney disease)

Frequent medicated bathing for skin problems

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Do you have any experience in working with dogs in the following areas? Check all that apply.

Please explain any other dog experience you have that might be helpful.

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Where will the dog spend its days?

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Where will the dog spend its nights?

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How many hours per day, on average, will the dog spend alone?

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Is someone home during the day? if not, what are your work hours?

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Who will care for the dog in your absence? (vacation, etc.)

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What backup plans do you have, or can arrange ahead of time, for the care of your pet(s), should you no longer be able to care for them?

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Pet History

Please provide the names of your current dogs.

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Are your current dogs male or female?

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Please provide the ages of your current dogs.

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What are the breeds of your current dogs?

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Please explain how many dogs you have owned in the last 10 years and what happened to them.

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Do your dogs spend most of their time indoors or outdoors, and why?

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If there is anything else we should know about your current dogs please explain it here:

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How many cats do you own currently and are they spayed/neutered?

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Please describe how many cats you have owned in the past 10 years and what happened to them.

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Were/are your cats indoor cats or outdoor cats?

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If any of your cats or dogs are not spayed or neutered, please explain why.

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How do your cats interact with dogs?

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Do you currently own any pets other than cats or dogs? If yes, describe them please.

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How do these pets interact with dogs?

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Disposition of Pets

If you have ever lost, surrendered to a shelter/rescue, placed in another home or given a pet away, please explain why.

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Please describe any unusual characteristics of your current pet(s) that Havanese Rescue should be aware of.

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Please provide any other information which you wish us to consider in evaluating your application.

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Havanese Rescue Inc reserves the right to refuse or deny any application. By submitting this form you attest that all the information contained in this application is complete and truthful. In addition, you expressly authorize Havanese Rescue Inc to verify the information on this application. Any misrepresentation will constitute grounds for automatic rejection. By submitting this form or acting upon any information provided by Havanese Rescue Inc (HRI), you are agreeing to forever, release, discharge, hold harmless and indemnify: any and all entities, corporations, and persons that are associated in any manner with Havanese Rescue Inc, the information, or the dogs; charged or chargeable with responsibility or liability, which includes but is not limited to: Havanese Rescue Inc and its Board of Directors, Rescue Volunteers, Web Designers, etc., including their heirs, administrators, executors, successors and assigns; from any and all claims, damages, costs, expenses, loss of services, actions and causes of action belonging to you and any other persons, corporations, or entities, arising out of viewing, using, or acting upon said information, which includes but is not limited to: any and all injuries, damages, or claims resulting from placing, obtaining or maintaining a dog or dogs.

NOTE: When submitting your application, please ensure that a confirmation page appears stating that your application was submitted successfully. If you don't see that page, it didn't work. You may need to try using another browser, computer, device (phones and tablets sometimes don't work).

Do you agree to allow a representative of Havanese Rescue Inc to visit your home by appointment?

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