We are committed to placing pets in the best possible homes. Please provide the following information to
assist in listing your pet under the Guardian Adoption Program (GAP).
Guardian's First Name
    Last Name
Address     City     Zip
Phone     Alternative Ph. *
Pet Name     Description
Reason for placing pet up for adoption
Are you a member of Safe Haven Animal Sanctuary? Yes No
Has the pet been spayed or neutered? Yes No
  If yes, date
  Veterinarian who performed procedure (name, address, ph no.)
Do you have current veterinarian records indicating shots received and present medical condition? Yes No
I agree and understand that this animal is being offered for adoption by myself as part of Safe Haven Animal Sanctuary's Guardian Adoption Program. This animal is not offered by Safe Haven Animal Sanctuary.
I agree and understand that I am completely responsible for the care and treatment of this animal until I have placed the animal with another guardian.
I agree and understand that Safe Haven Animal Sanctuary is not responsible for the care or treatment of this animal, nor any veterinarian bills this animal may have or will incur.
I agree and understand that I will review prospective GAP Adopter Agreements (Adopter Profiles) and promptly respond to any such inquires.
I agree and understand that Safe Haven Animal Sanctuary will list my pet on the web site for six months and I may renew the listing at no additional cost, for an additional six months by my request.
I agree and understand that I will contact Safe Haven Animal Sanctuary promptly when the pet is no longer available for adoption.
I understand that a donation will help Safe Haven Animal Sanctuary defray the expenses of offering this service and will donate at least $20.00 to Safe Haven Animal Sanctuary for the first listing and $10.00 for each subsequent listing within one year. (SHAS members donate $10.00 for each listing.)
I have donated online with PayPal.
I will send in my donation by check (check donation form).
I will send in my donation by credit card (credit card donation form).
Email me a copy of this submission Yes No
* denotes optional
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Safe Haven Animal SanctuarySM
Mailing: PO Box 9005
San Jose, CA 95157
Telephone: (408) 420-SAFE (7233)
Fax: (866) 833-2451 (toll free)
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