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Adoption Application

Every dog deserves a safe haven and a family of their own. Complete our adoption application and tell us about your household, lifestyle, and the dog you’re hoping to welcome into your family.

Prefer paper? Download the PDF All applications

Using the paper form? Fill it out and email it to tillies.safehaven@gmail.com.

Fields marked with an asterisk are required.

Applicant Information

Full Name

Date of Birth

Optional.

Street Address

City

State

ZIP

Phone

Preferred method of contact

PhoneTextEmail

Occupation

Employer

Optional.

Household Information

How many adults live in the home?

How many children?

Children's ages

Does everyone in the household agree to adopting a dog?

YesNo

Anyone in the household have pet allergies?

YesNo

About the Dog

Daily Care

Where will the dog stay during the day?

Where will the dog sleep at night?

How many hours will the dog typically be alone each day?

0–23–56–8More than 8

Who will be primarily responsible for the dog's care?

How will the dog receive exercise?

Current Pets

Do you currently own pets?

YesNo

Current veterinarian

Clinic Phone

Veterinary Reference

I authorize Tillie's Safe Haven to contact my veterinarian regarding my pets' care history.

Initials

Personal References

Reference 1

Name

Relationship

Phone

Reference 2

Name

Relationship

Phone

Expectations

I understand that:

Owning a dog is a long-term commitment.

Dogs require training, exercise, veterinary care, and patience.

Adjustment to a new home may take several weeks.

Adoption fees help support rescue efforts and are generally non-refundable.

Approval of this application does not guarantee adoption of any particular dog.

Certification

I certify that the information provided is true and complete to the best of my knowledge. I authorize Tillie's Safe Haven to verify the information provided, including landlord, veterinarian, and personal references. I understand that falsifying information may result in denial of my application.

Full legal name (typed signature)

Typing your full legal name here serves as your signature.

Date

Filled in automatically.

Adoption Application

Applicant Information

Household Information

Residence

About the Dog

Daily Care

Current Pets

Previous Pets

Veterinary Reference

Personal References

Expectations

Certification