Name of dog you would like to adopt:

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How did you hear about this dog?

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Does not apply

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Applicant's Info

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Applicant:

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Age: Occupation: Wk Phone #:

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Does not apply

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Other Adults/Children that will be living with the dog:

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Does not apply

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Home Phone #: Cell Phone #:

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E-mail Address:

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Current Address:

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City / State / Zip:

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How long have you lived at this address?

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Do you plan on moving? If so, when?

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Household setting: Urban Suburban Rural

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Household type: Apartment Condo Townhouse Duplex House Modular Home

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What is your current living situation: Own Rent

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If renting:

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Does not apply

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ATTENTION RENTERS: A COPY OF YOUR LEASE OR A NOTARIZED STATEMENT FROM YOUR LANDLORD CONFIRMING THE WEIGHT REQUIREMENTS OF A DOG IS PERMITTED, MUST BE ATTACHED OR THE APPLICATION CANNOT BE PROCESSED

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Does not apply

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If no fence, describe how you will exercise your pet safely:

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Does your city or county have a limit of pets per household? Yes No

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If so, what is the limit?

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Local Animal Control Phone #:

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Vet Info.

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Veterinarian's Name: Phone #:

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Does not apply

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*Note: You may want to call your vet and OK the release of records. Thank You!*

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Important Info.

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Please list all household pets that have resided in your home in the last 5 years:

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Does not apply

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Have your dogs ever bitten anyone or shown any signs of aggression toward another dog or person? If so, which dog and please, explain the outcome.

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Do you know how to break up a dog fight? Yes No Please, explain.

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Have you ever been bit by a dog? Yes No What happened to the dog?

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Have you ever had an animal euthanized? Yes No Please, explain

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Have you ever surrendered an animal into Animal Control? Yes No Please, explain

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Have you made provisions for your animals in case of an emergency? Yes No Please, explain

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What brand of dog food will you be feeding the dog?

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How often and how many cups will the dog be fed daily?

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Where will pet stay when no one is home? basement garage dogroom free in home yard

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other

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Where will pet stay at night? basement garage dogroom free in home yard

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other

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Is anyone home during the day? yes no

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Please list who and the amount of time:

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Daily work or at home schedule:

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Applicant:

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Estimated daily time you will spend with your dog:

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Describe the general activity and noise level of the household:

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What activities will your dog have? Daily Walks Lap Time Dog Park Dog Hikes

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other

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Do you plan on bringing your dog to obedience class? yes no

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Name of facility:

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Under what circumstances would you not keep your pet?

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If you or your Spouse should separate or divorce, what will happen to the dog you are wanting to adopt from us?

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Are there any specific habits or problems, you will not allow in your house?

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I have adopted from a rescue group or shelter before: Yes No

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(Name & Number)

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I realize that a rescue dog, may need a long transition period: Yes No

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Would you consent to a home visit prior to adopting? Yes No

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Is there any other information you would like to add, to assist us in processing your application?

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Please list 4 references (Name and Phone number) *CANNOT BE A RELATIVE:

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1.

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2.

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3.

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4.

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Date:   12/21/2024

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Filling out this application does not guarantee you can adopt an animal from Noah's Arks Rescue. We have the right to reject an applicant based on the information obtained on the application, through a reference or home visit. Our primary goal is for the welfare, health and happiness of an animal we have rescued and saved from being euthanized. These animals have become part of our Family and we want to make sure they are loved and taken care of for the remainder of their natural life.

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THANK YOU FOR CHOOSING TO ADOPT A RESCUED ANIMAL!