Noah's Ark Animal Rescue and Placement
Pet Adoption Application

The following information is requested so we can assist you in the selection of a new pet.
The animal.s welfare is our foremost concern.
The consultation process is designed to help us assist you in finding the animal most compatible to your lifestyle.

Please fill in all fields marked with a *
Animal Interested In *
Applicants Name *
Address *
City *
State *
Zip Code *
Phone Home *
Phone Work
Drivers Licence
Email Address *
How did you hear about Noahs Ark
Is this your first experience with a pet Yes No *
Do you have other pets at home Yes No *
If yes, tell us about your other pets below:
Pet Type Altered Vacinated Where is the Pet Kept Age Name
Any additional information on your pets
If you presently own a cat or kitten has it been tested for FIV and Leukemia Yes No
Results Positive Negative
If you dont have pets now have you had any in the past Yes No
If yes, tell us about your past pets below:
Pet Type How long did you have the pet? Pets Name Where is the pet today
Veterinarian's Name
Veterinarian's City, State
Veterinarian's Phone
Approximate date of your last vet visit
Have you ever had to find another home for one of your pets Yes No *
If yes why
How did you do that
How long have you resided at your present address *
Do you currently live in a House Apartment *
Condo Other -Please Specify:
Do you Own Rent *
If renting does your lease allow pets Yes No
Landlords Name
Landlords Phone
How many people live in your household
Do all the adults know you plan to adopt Yes No *
Are there any children in your household Yes No *
Ages
Does anyone in your household have any known allergies to animals Yes No *
Where will this pet be kept during the day Inside Outside *
Is anyone home all day Yes No *
If no how many hours will the pet be left alone in a 24 hour period *
Where will the pet be kept when alone *
Are you financially prepared to give your new pet routine and emergency medical care such as rabies vaccinations inoculations preventative medications exams for parasites earmites etc Yes No *
Would you object to a visit or call from a Noahs Ark representative to see how you and your new pet are doing Yes No *
DOG/PUPPY ADOPTIONS ONLY:
Do you want the dog for a (select all that apply): House Pet
Guard Dog
To Breed
Watch Dog
Companion for another pet
Companion
Gift
Other:
Please Specify
Do you realize you will probably have to housetrain the dog Yes No
Are you familiar with crate training Yes No
Are you familiar with leash licensing laws in your community Yes No
How will you keep your dog confined to your property (select all that apply): In Home
Chain/Tie Out
On Leash
Kennel
Garage
Wireless Fence
Fenced Yard
Patio or Deck
Other:
Please Specify
Do you have a fenced yard? Yes No
If Yes, How high is it and what is it made of?
What will you do if the dog chews furniture or shows other destructive behavior?
Do you need an explanation of how to introduce a new dog to your current pet(s)? Yes No
Are you familiar with feeding recommendations for a dog/puppy? Yes No
You may use this space below to add any information that you want included and considered along with your adoption application.

              

If you have trouble with this application, you can download our Microsoft Word compatible version HERE