If you rent, what is the name and phone number of your landlord?
Current and Past Pets
Animal You Wish To Adopt
I certify that I am at least 21 years of age and the information I have given is true. I recognize that any misrepresentations of facts may result in my losing the privilege of adopting a pet. I authorize any and all verifications of statements made in the application, and I understand that Pets Haven Humane Association, Inc. has the right to deny my application. I am fully aware that I am adopting a living creature and as such that Pets Haven Humane Association, Inc. is unable to guarantee the health of the animal. If this animal becomes ill, I certify that I am financially and emotionally prepared to treat this animal at my own expense. I am aware that the life expectancy for a dog is as much as 22 years and believe that I will be able to properly care for this animal for the rest of its life. If I am ever unable to continue to care for this animal, I agree to return it to Pets Haven Humane Association, Inc..