Noahs Ark Rescue Adoption Application

First Name

Last Name

Street Address

Address Line 2

City

State

Zip Code

Phone Number

Email Address

Name of pet you are interested in adopting:

Do any family members have allergies to this breed?

Are all members of your household in favor of adopting this pet?

Please list the names and ages of all people residing in your household:

Please list pets you currently own. (Include their name, type of animal, age, sex, spayed/neutered, indoor or outdoor)

Please list all other animals you have owned in the last ten years that you no longer own. (List name, type of animal, sex, spay/neutered, indoor or outdoor, and what happened to the pet.)

Do you currently own or rent?

If you rent, do you have your landlord's permission to adopt this pet?

If renting, please provide the name and phone number of your landlord.

Please list two personal references:
Name

Phone

How long have you known each other?

Name

Phone

How long have you known each other?

What traits would you most like in your new pet?

What behaviors would you have a hard time dealing with?

Where will your pet stay during the day?

Where will your pet stay during the night?

Do you have a fenced yard?

Yes

No

Will you tie your pet in the yard?

Yes

No

How many hours per day will the pet spend without human companionship, and where will you leave your pet when no one is home?

Do all members of your household understand that if takes time for a new pet to adjust to the new environment?

Yes

No

Would you be able to tolerate a few accidents in your house while your new pet adjusts to your home?

Yes

No

Do you know that pets require veterinary care, yearly vaccinations, and monthly wormings?

Yes

No

Do you know about heartworm, the test and monthly preventative pill for the disease in dogs?

Yes

No

Do you agree to notify Noahs Ark if your pet ever becomes lost?

Yes

No

Do you agree that an adopted pet will be kept exclusively as a house pet, and will never be tied out or chained to a dog house or any other object?

Yes

No

Do you agree that if, for any reason, you could not keep an adopted pet you would notify Noahs Ark immediately and never give it to a shelter, pound, or other person?

Yes

No

Please notify your current veterinarian (or last veterinarian used) that Noahs Ark Rescue will be contacting them and give permission for them to verify any of your current or past pets' medical records. (Please list your Vets name, address, phone, and the name under which your records are kept.)

Adopting a pet is a great responsibility. You will be sharing your life with an animal that is totally dependent upon you for food, shelter, clean up and veterinary care. This involves a financial commitment. Are you willing to make this committment to your new pet?

Yes

No

Indicates Response Required