Please complete all required fields!
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.
You must be 18 years of age or older to adopt a dog.
If you're interested in fostering you will need to complete a volunteer application in the Volunteer Section of our website.
If you are interested in a specific dog for adoption please enter the dog's name from our website here.
Please select the state the dog is located in if different than yours. If you are not specifying a particular dog leave this blank.
Puppy Only (1-12 mo)
Young (1-2 years)
Middle Age (2-7 years)
Senior (8+ years)
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
Family Member 2
Family Member 3
Family Member 4
Please provide relevant information on other regular/frequent visitors to the home, including grandchildren, neices/nephews, eldery/disabled people, etc.
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.
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.
Dog Care and Guardianship
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
Physical handicaps (blind, deaf, etc)
Other, please explain below
Disposition of Pets
Changing lives ... one Havanese at a time.