If you are interested in our adoptable animals, please fill out an application completely and submit.

  • Please read our Adoption Policies.
  • All of our pets are updated with shots/vaccines.
  • An adoption fee is required to cover our rescue expenses.

    Adoption Application


       Thank you for your interest in adopting 'QQQ'!

    Please Notes: This application might seem lengthy because we are trying to determine the best match possible for you as well as 'QQQ'. After submitting the application, it will be reviewed and we will reply with a response or further questions as soon as we can. If you have any additional comments or questions please put them in the comment box on this form! Also, incomplete applications will take longer to be processed.

    * - denotes required field.

    First Name*        Last Name*  
    Address*  
    City*  
    State*       Zip*  
    Previous Address/Location* 
     
    Email*  
    Email Verify (Please type again)*  
    Home Phone*  ()   -
    Cell Phone  ()   -
    Work Phone  ()   -
     
    Job Description:  
    Age*  
    Drivers License #  
    License State  
     
    Family Status  
    Have roommates     How Many  
    Have children     How Many and Ages  
    Interested in:  QQQ
    My housing  
    Have screens on windows?  
    Have secured fencing in yard?  
    'QQQ' will be kept  
    During Day  
    During Night  
    Location inside, either during the day or night  
    Location outside, either during the day or night,  
    Length of time at current address   
    Landlord Name*  
    Landlord Phone*  
     
    Current Pets:*  Please include all pets, including small caged and barnyard animals and list the following for each pet: Type of Pet, Age, Sex, Spayed/Neutered, Kept In/Out, How long owned
    Pet History:*  Please list pets owned in the past 5 years (other than those above) and list the following for each pet: Type of Pet, Spay/Neutered, Kept In/Out, How long owned, What happened to pet
    Veterinarian:*  Please enter the following if you currently own animals or if you have owned animals in the past: Veterinarian Name, Address, Phone
    Responsibility:*  Who will be responsible for the pet’s care?
    About:*  Why are looking to adopt a dog or specifically 'QQQ'?
    Length of time during the day  
    'QQQ' will be left alone?*      		 
    If extended trip,'QQQ'  
    will be taken care by?  
    Potential mismatch:*   What do you consider an acceptable reason for giving up an animal?
    References:*  
    Comments or Questions:  
    Where did you hear about AHAN? 
     
    Have you ever adopted an animal 
    from a shelter, rescuer group 
    or organization before? 
    If yes, what was the name and city 
    of the shelter, rescuer group 
    or organization:  
    Were you satisfied with your 
    experience with them? 
    If not satisified, what was 
    the reason:  
     
    I hereby authorize to release AHAN all veterinary records on any and all animals I own or have owned:
    YesNo
    I have downloaded and read the following adoption agreement, am willing to abide by it and will sign it if I am selected to adopt the animal as well as I am willing to pay an adoption fee which covers the animal rescue, adoption and medical expenses. *** Important Application Printing Instructions ***
    YesNo
    I certify that all the information in the application is true and I understand that false information may void the application and I understand that submitting of this application is no guarantee that I will be able to adopt the animal that I have selected to adopt.
    YesNo
     
    Choose a second choice if 'QQQ' is unavailable?
    Currently: None Chosen
     
    Security Field to Prevent Automatic Form Submission: Please select a color from the following pulldown: *
     
           




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