Noahs Ark Rescue Adoption Application
First Name
Last Name
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
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?
Independence
Dependence
Gentleness
Rough Housing
Quiet
Calm
What behaviors would you have a hard time dealing with?
Dominance
Stubborn
Quiet
Destructive
Chewing
Escaping
Jumping on People
Digging
Aggression
Excessive Barking
Nervous or Shy
Too Energentic
Too Friendly
Biting
Submissiveness
Noisy
Overly Protective
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
Powered by
FormSite.com