Application for Pet Adoption

Information provided in this application will become an official / binding agreement of the adoption contact if a pet is adopted through our agency.  

What is the name of the pet you are considering? ____________ Date: __________
Name of person adopting pet: ______________________________
List all other adults residing in the household:
Number of children in home: ____ Ages: _____________________

Street Address:
City, State, Zip
Home phone:
Cell phone:
Work phone:
E-Mail Address(s): ____________________________
Drivers License # _______________ State ______
Place(s) of Employment: ________________________
Spouse: _____________________________________
Occupation(s): ________________________________

How long at your current address?
What type of housing?   House   Duplex   Condo   Apartment   Modular Home
If you rent/lease, do you have permission from your landlord to keep a pet?
Landlord’s Name:
Contact Phone Number:
Do you have a fenced yard?
            What type of fencing?

Are you a current/previous dog owner?
Are you a current/previous cat owner?
Please list what happened to any previous pets that are not currently in your home:
What other types of animal(s) currently live in your home?       

Is anyone typically home during the day? (y) (n) Who? ______________
Is anyone typically home at night? (y) (n) Who? _______________
Are you willing to crate-train if needed? (y) (n)
Is anyone in the home allergic to pet dander? (y) (n) If yes, who? _________________________
Where will your pet be kept:
            During the day?
            During the night?
            When you are away from home?

Are you familiar with vet costs, such as annual shots, routine care and/or unexpected expenditures? Are you aware of the importance of YEAR ROUND Heartworm Preventative and Flea Treatments?
Are you willing to have a Home Visit prior to the adoption?
Are you willing to allow a NOAH’S ARC volunteer to conduct follow up contacts after the adoption, including home visits and seeing the animal at anytime we deem necessary? (y) (n)
            Int. _____    N/A volunteer Int. _____

Please provide the following veterinary information:
Name of Vet:
Name of Vet Clinic if applicable:
Name of all Pets Serviced at this Vet –

Second Vet if applicable:
Name of Vet:
Name of Vet Clinic if applicable:
Name of all Pets Serviced at this Vet –

If you have not owned a pet in the past two years, please provide a personal reference not related to you. (Provide Personal Reference ONLY if you have not owned a pet in the last two years.)
Name of Reference:

Applicant Signature/Date____________________________________
Adoption Coordinator Signature/Date________________________ 
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