Harley's Haven Dog Rescue -
Adoption Application
Please note: All pets
*MUS
T* be current on their vaccines AND spayed/neutered unless there is a documented medical reason.
This includes "indoor only" cats.
The rabies vaccine is required by law in PA.
If your pets are not current, your application will be denied.
~~~ Our adoption radius is roughly one (1) hour from Perkasie, PA 18944 ~~~
Name of dog you are applying for:
**Please note we are not accepting applications at this time for preapproval. Application must be for a specific available dog.**
How did you hear about Harley's Haven Dog Rescue?
Date
MM
/
DD
/
YYYY
Are you a Veteran or have been honorably discharged or are currently an active military service person?
Yes
No
Name
**** PLEASE NOTE OUR ADOPTION RADIUS IS ONE HOUR FROM PERKASIE, PA 18944 ****
Address
Phone
Email
Birthdate
Please note applicants must be 21 years or older.
Excluding yourself, please list NAMES and AGES of
ALL
household members (this includes children, roommates, etc)
Is everyone in your household support your intentions to adopt a dog?
Yes
No
It's a surprise for a family member
Our household is still discussing
Do you own or rent your home?
Own
Rent
If you rent, please list your landlord's / Property Management's name and phone number.
What type of home do you live in?
Single family home
Condo
Twin / Duplex
Apartment complex
Townhome
Other (if selected, please explain below)
If OTHER was selected above, please explain:
Do you have a HOA/ Community Association/ Management Company where you live?
Yes
No
HOA/ Community Association/ Management Company contact information (name & phone number):
Are there any breed/ weight/ size/ number of animals restrictions?
Yes
No
Do you have a yard?
Yes
No
Yard size:
Is your yard fenced in?
Yes
No
Type of fence:
No fence
Partially fenced
Electric fence
Chain link
4 foot fence
6 foot fence
Other (if other, describe below)
If OTHER was selected above, please explain:
Name, address, and phone number of your employer:
Please included a contact name.
Length of time with current employer:
**
Please contact your Veterinarian's office to give permission to release your records. Not doing so will result in processing delays.
Do you have pet experience?
I currently have a pet(s)
This would be my first pet
I currently do not have a pet but have owned pets in the past
Name, age, breed of current pet/pets:
If none, write N/A
Are all of the pets listed above spayed/neutered and current on vaccines, including rabies?
All pets, including indoor only cats, must have up-to-date annual vaccinations in order to move forward with your application.
Yes
No
If NO, please explain:
Name and phone number of your current Veterinarian. If you do not have a Veterinarian, write N/A
How long has the above been your veterinary place of service?
Previous Veterinarian name and phone number, if any:
If you do not have current pets, have you had pets within the last 5 years?
If yes, please describe and if the pets were spayed/neutered and current on vaccines?
Have you ever had to give up an animal? If yes, please explain the reason:
Please inform your references they will be receiving an email from our team in the next few days. All references are contacted via email.
Personal Reference #1:
Please provide name, phone number, and relationship. **MUST BE SOMEONE THAT DOES NOT LIVE IN THE SAME HOME
Email address for Reference #1:
Applications without Personal Reference emails will not be processed.
Personal Reference #2:
Please provide name, phone number, and relationship. *MUST BE SOMEONE THAT DOES NOT LIVE IN THE SAME HOME
Email address for Reference #2:
Applications without Personal Reference emails will not be processed.
Who will be the primary caregiver of this dog?
Why do you wish to adopt this dog? Please check all that apply:
Companionship for me
Companionship for another pet
Love animals & I want to help a pet in need
Guard dog for home/property
Outside pet
I want to breed this pet
Our pet passed away and I am ready to welcome a new family member
I have been looking for a specific type/breed and have been waiting
This would be a gift for someone
Why do you feel this dog would be a welcomed member in your household?
If your dog/pets were to survive you, what would happen to them? Who would assume responsibility for them? Is this person listed aware of this?
What is your preferred level of energy/exercise when it comes to a dog? Select all that apply:
Total couch potato
Short walks
Yard exercise
Vigorous walks
Hiking and jogging
Long runs / strenuous exercise
I'm ready for puppy chaos / puppy energy
Looking for a dog that doesn't require a lot of energy / exercise
Other (explain below)
lap dog only
If OTHER was selected above, please explain:
Dog preferences (select all that apply)
Young puppy (8 wks to 6 months)
Mature puppy (7 months to 1 year)
Young adult (1 year to 3 years)
Adult (3 years to 6 years)
Senior (7 years to 10 years)
Golden years (11 years and older)
Age doesn't matter if it's the right fit!
Small size dog (under 25 lbs fully grown)
Medium size dog (26 lbs to 60 lbs)
Large size dog (61 lbs and larger)
Size doesn't matter if it's the right fit!
Male
Female
Sex doesn't matter if it's the right fit!
Short hair
Long hair
I do not have a breed preference
I have a breed preference and it's listed below
Other (list below)
If OTHER was selected above, please explain:
Where will your dog spend their time when you are not home? Select all that apply:
Free roam inside house
Basement
Crated only when no one is home
Outside in a dog run
Inside a closed room
Other (specify below)
Garage
If OTHER was selected, please explain:
Approximately how many hours per day will your pet spend alone?
Where will your dog spend their time at night? Check all that apply:
Free roam of house
Garage
Crated
Basement
Inside a closed room
Outside
In my bed!
Other (specify below)
Where ever the dog decides to sleep!
If OTHER was selected, please explain:
Which of the following behaviors or characteristics would present a problem? Select all that apply:
Jumping on furniture
Digging
Jumping on people
Poor leash manners
Chewing shoes, furniture, etc
Accidents in the house
Barking / howling
Nothing, I understand dogs require guidance and/or training from myself
Shedding
Other (specify below)
If OTHER was selected, please explain:
What can you tell us about the breed you would like to adopt?
Harley's Haven is a foster-based rescue. We do not have a facility/boarding kennel. It is our policy to not "hold" dogs for a length of time once an application is approved (example: vacations, moving, travel). Please only apply if you are truly ready *now* to bring a new dog into your home.
If your application is approved, is there anything that would prevent you from having the dog start it's foster-to-adopt within the next week?
All initial vet care that is included with this dog's adoption is done at Pennridge Animal Hospital in Perkasie, PA. Multiple visits to the hospital may be required.
This would not be an issue.
This would be an issue due to distance, etc
If the dog you are applying for is already spoken for, do you want us to still process your application? Approved applications are held for 3 months.
Yes
No
Have you applied to foster or adopt from another rescue or shelter?
Yes, I was approved and adopted.
Yes, I was approved but did not adopt
Yes, I applied and the application is processing
Yes, I applied and never heard back.
Yes, I applied and was denied.
No, I have never applied.
If you have been approved elsewhere, please list he shelter or rescue name(s). If not applicable, write N/A
Is there any thing else you would like us to know when processing your application?
Disclaimer: There are several reasons we may choose to deny your request to foster/adopt with us. These reasons include but are not limited to: negative references from veterinarian and/or personal references, lack of permission from landlord, rescue dog meeting current pet(s) is unsuccessful, inappropriate match of rescue dog to family, applicant name found on a “Do not adopt” list, etc . Completing an adoption application is not a guarantee that you will receive the dog you are applying for, and Harley’s Haven Dog Rescue reserves the right to reject any application as we see fit.
By typing my name below I certify the information contained in this form is true and correct. I give permission for representatives of Harley's Haven Dog Rescue to contact my references and my veterinarian. This application is a non binding agreement. Applicant is under no obligation to adopt a dog and Harley's Haven Dog Rescue is under no obligation to provide a dog to the applicant.
Name
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