Papillon Haven Rescue
A Safe Place for Papillons and the People Who Love Them

ADOPTION APPLICATION
(Instant Electronic Submission Form)

This may seem like an excessively detailed, even invasive, questionnaire but please keep in mind that the more information we have about you, your household and your expectations of your rescued dog, the easier it will be to make a successful match. Finding the perfect match between adopter and dog is our most important goal.

Date: April 29th, 2024
Your Name:
Your Birthday:
Street Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Cell Phone:
E-mail Address:
1. How did you learn about Papillon Haven Rescue? (Check all that apply)
PapHaven Web Site
Petfinder Web Site
Adoption Event
Newspaper Article
Radio Announcement
TV Announcement
Word-of-Mouth
Just stumbling onto us
Foster Flunky
Facebook
Other
2. Have you applied to adopt a rescue Papillon or other companion pet from another group? Yes No
Have you ever surrendered a pet to a shelter or a rescue group? Yes No
If so, why?

Household:
3. How many adults in the household?
4. Please list their names, ages and occupations:

5. How many children in the household?
6. Please list their names and ages:

7. If no children in the home, do grandchildren, nieces/nephews or other kids ever visit? Yes No
Caregiver:
8. Who will be the primary caregiver for ?

9. Does this person work away from the home? Yes No
10. How many hours per day will be left alone?
11. How long at current address?
12. Is it a house, condo, apartment or other (please specify)?

13. Do you own or rent? Own Rent
14. If you rent, please provide the name and phone number of the property owner:

Fence:
15. Do you have a securely fenced yard? Yes No
16. If so, what type of fence is it (wood, chain link, block wall, etc.)?

17. How many feet high is it? (Please enter a number with no spaces)
18. Is there a doggie door leading to the yard? Yes No
No Fence:
19. If you do not have a fenced yard, where and how often do you plan to take to potty?

20. Will be on a leash? Yes No
21. Under what circumstances would you allow to be off-leash?

Inside:
22. Are there any areas of the house where will not be allowed? Yes No
23. If so, how will you keep out of them?

24. Will be allowed on the furniture? Yes No
25. If not, how will you keep off the furniture?

26. Will be given the run of the house when no one is at home? Yes No
27. Where will sleep?

Training:
28. Please note that almost all rescued dogs are crate trained before being placed in their forever homes. Most dogs enjoy the security of their crate, although a few will not like being confined.
Will you provide a crate for ? Yes No
29. Have you ever trained a dog to respond to simple commands? Yes No
30. If so, how would you describe the method you used?

31. How will you discipline for undesirable behavior?

32. If is not housetrained, how will you housetrain ?

33. Are you aware that even housetrained dogs need a period of adjustment in a new home? Yes No
34. What will you do if has "accidents" in the house?

Experience:
35. How many dogs have you owned?
36. How many years did you have your last dog?
37. How many years ago?
38. Did you have the dog until it died? Yes No
39. If so, at what age did it die?
40. If not, what happened to it?

41. Was it spayed/neutered? Yes No
42. Do you currently have one or more dog(s)? Yes No
43. If so, please list their breed, age, sex and whether they are spayed/neutered:

44. Where have your previous or current dogs mostly lived? Indoors Outdoors
45. Do you have any other pets or farm animals? Yes No
46. If so, please list species:

47. If you have one or more cat(s), describe how you hope will interact with it:

Health:
48. Do you or anyone in the household smoke? Yes No
49. How do you intend to exercise ?

50. Is your lifestyle vigorous and active or not so active? More Active Less Active
51. Do you travel a lot? Yes No
52. When you go out of town, what arrangements will you make for the care of ?

53. If anything were to happen to you, what do you anticipate would happen to ?

Reasons:
54. Why do you want a dog (or another dog) at this time?

55. Why do you want a Papillon in particular?

56. Have you ever had a Papillon before? Yes No
57. Have you ever had a rescued dog before? Yes No
58. Why do you want a rescued dog?

Characteristics:
59. What characteristics would you like to see in ?
60. What characteristics would you NOT like to see in ?
61. What will you do if has some unwanted characteristics?
62. What is the age range of the dog you hope to adopt?
63. What gender dog do you hope to adopt? Male Female Either
64. Why do you want this particular gender?

65. How important to you is it that already be housetrained? Very Important Will train
66. Are you willing to adopt a special needs dog (requires medication, deaf or blind, etc.)? Yes No
67. If so, which of the following special needs would you be willing to adopt? (Check all that apply)
Elderly or Fragile
Crippled or 3-legged or using Prosthesis
On Medications for Serious Conditions (e.g. Diabetic, Bad Heart, etc.)
Deaf or Near Deaf
Blind or Near Blind
68. Are you aware that Papillons can be big barkers? Yes No
69. What will you do if barks a lot?

References:
70. Please provide the name and phone number of your current or previous veterinarian:

71. Please provide the names and phone numbers of two personal references, not including family members:

Agreement:
72. Do you agree to have a representative of Papillon Haven Rescue visit your home prior to adoption? Yes No
73. Do you agree to a follow-up visit after adoption? Yes No
74. Do you agree to pay an adoption fee of $200-$425, depending on age, health and possible special needs of ? Yes No
75. Are you ready and willing to make a lifetime commitment to ? (a Papillon can be a 15 to 20 year commitment) Yes No
76. Are you financially able to care for , including medical emergencies? (regular vet visits and vaccinations) Yes No
77. Please enter one of your Drivers License (with State) or your Social Security Number.

Thank you for completing this application and thank you for wanting to give a forever home to one of our rescued Papillons. NOTE: Your application to adopt any PapHaven Papillon applies to all PapHaven Papillons. BEFORE YOU SUBMIT this form, please go back up and review your answers one last time. Once you submit the form, you will have to submit a new form to change any of your answers. When you are happy with your answers, print this form for your records and submit the form.

TRANSMITTING FORM
I understand that any misrepresentation of fact may result in my not being approved to adopt a dog.
**NOTE** We reserve the right to refuse or deny any application for any reason.

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WARNING: This form CANNOT be copied and pasted without losing information. Use the SUBMIT button above.
Revised: 2009-02-11