Adoption Application

Please read this first. Occasionally, potential adopters provide foster care for a rescue dog before the adoption is finalized. This gives everyone time to see if the dog is a good match for the family. Due to this, we ask that you complete all sections of this application, even if you don't plan to become a regular volunteer for Havanese Rescue. Thank you! If you are interested in volunteering with HRI, please register as a volunteer. NOTE: You will be asked to provide the names and phone numbers for FOUR personal references and one veterinary reference. Please collect that information prior to beginning the application. If you find that your computer is not cooperating, you may request that a paper Adoption Application be sent to you. Please email us HERE to send your address.
Residence Location
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IMPORTANT! 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.

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You must be 18 years of age or older to adopt a dog.

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Invalid Input. Must match email address entered in previous box.

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Tell us if you would consider fostering prior to adoption, or if you are interested in only adoption.

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If you are interested in a specific dog for adoption please enter the dog's name from our website here.

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Address Information
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Household Member 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
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Family Member 2
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Family Member 3
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Family Member 4
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Other Visitors
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Please provide relevant information on other regular/frequent visitors to the home, including grandchildren, neices/nephews, eldery/disabled people, etc.

Residence Details
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Personal References 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.
Reference 1
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Reference 2
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Reference 3
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Reference 4
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Veterinary Reference 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.
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Dog Care and Guardianship
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Pet History
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Disposition of Pets
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Havanese Rescue Inc reserves the right to refuse or deny any application. By submitting this form you attest that all the information contained in this application is complete and truthful. In addition, you expressly authorize Havanese Rescue Inc to verify the information on this application. Any misrepresentation will constitute grounds for automatic rejection. By submitting this form or acting upon any information provided by Havanese Rescue Inc (HRI), you are agreeing to forever, release, discharge, hold harmless and indemnify: any and all entities, corporations, and persons that are associated in any manner with Havanese Rescue Inc, the information, or the dogs; charged or chargeable with responsibility or liability, which includes but is not limited to: Havanese Rescue Inc and its Board of Directors, Rescue Volunteers, Web Designers, etc., including their heirs, administrators, executors, successors and assigns; from any and all claims, damages, costs, expenses, loss of services, actions and causes of action belonging to you and any other persons, corporations, or entities, arising out of viewing, using, or acting upon said information, which includes but is not limited to: any and all injuries, damages, or claims resulting from placing, obtaining or maintaining a dog or dogs.

NOTE: When submitting your application, please ensure that a confirmation page appears stating that your application was submitted successfully. If you don't see that page, it didn't work. You may need to try using another browser, computer, device (phones and tablets sometimes don't work).

Changing lives ... one Havanese at a time.