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Dog Application
Pet Interested in:_______________________
Today's Date: ___________________________
Pet ownership is a serious responsibility. This policy of the adoption group is to assure that
each person who adopts a pet is aware of the responsibility, and that each is capable and willing
to accept that responsibility morally, physically, and financially. It is quite true that not
everyone who desires to own a pet should have a pet.
The following questionnaire has been designed to aid both you and the adoption group in deciding
if you and/or your family is indeed at this moment adequately prepared to assume the type of
responsible ownership which we are endeavoring to assure for our adoption animals.
Please be sure to answer all questions and feel free to add your own comments. If a question
does not apply write N/A.
Name:_________________________________________________________ Age: ___________
Phone: (Day) ________________ Phone: (Eve) _________________ Email: ___________________________
Name of spouse/signficant other/roommate:_______________________________________________________
Address:_______________________________ City:______________________________ Zip: ___________
Occupation:____________________________________ Spouse: _______________________________________
If this relationship were to change, with whom would the pet remain?:___________________________
Do all adults in your household know you plan to adopt? Yes______ No ______
Who will be primarily responsible for the pets care? ___________________________________________
What are your reasons for adopting a pet? A companion for you ________ Your cat/dog ______
Spouse ________ Children _________ Gift (for who?) __________ Mouser ________ Other________
Guard dog (for home or business?) ______________________________________________________________
If for business, what type of business? ________________________________________________________
Business Address: _____________________________ City: ____________________________ Zip:_________
Your type of Dwelling (house,apartment,condo) _______________________ Own or Rent ____________
If you rent, are pets allowed? (Yes/No) ___________ Length of residency ____________________
In your selection of a dog/cat, what is your preference? Breed ________________________________
Age________ Long/Short Hair ____________ Sex _______ Color___________ Personality _________
This cat/dog will be: Indoor only ________ Mostly Indoor _________ Mostly Outside ___________
Outdoors only ___________ Other ______________________________________________________________
If you answered indoor only, please describe what outdoor access the pet will have
(when will it go out, etc.)
________________________________________________________________________________________________
If you have children, please list their ages: __________________________________________________
Have your children ever been around cats/dogs? Yes________ No __________
Has a cat/dog ever bit your child? Yes __________ No ___________
Do your current pets like cats/dogs? Yes __________ No ___________
Have you every bred a cat/dog? Yes __________ No ___________
If yes,did you breed for: Fun _______ Show ______ Profit ________ Accidentally happened ______
If you presently own a dog has it been neutered/spayed? Yes __________ No __________
If not why? ____________________________________________________________________________________
Do you plan on breeding your new dog? ______________________________________________________
Has your cat/dog been vaccinated? ____________ If so, date of the last vaccine? _______________
At what age should a dog be altered (spayed/neutered)? 4 months _____________
6 months ________ 1 year __________ After first heat ____________ After one litter __________
PAST/PRESENT PET HISTORY
Breed Age Spayed/Neutered?(Y/N) Kept Inside or Out Do you still have this pet? If not, why?
_______________ _______ _______________ ___________________ _________________________________________________
_______________ _______ _______________ ___________________ _________________________________________________
_______________ _______ _______________ ___________________ _________________________________________________
In regards to the above questions, what happened to your pet(s)?
Hit by car ________ Old Age __________ Died of disease ____________ Gave Away________
Gave to Shelter_________
(Why) ________________________________________________________________________________________
______________________________________________________________________________________________
Other
______________________________________________________________________________________________
______________________________________________________________________________________________
What outside space is available for the dog? Fenced yard ___________ Height __________
Type of Fencing? Chain Link _____________ Block Wall ________________ Wood ______________
Other ________________ Locks on gates? ______________________
Other provided living areas: Garage ___________ Balcony _________ Unfenced yard _________
Kennel Run ________________________ Other ___________________________________________________
Do you have a: Balcony ________ Pool ________ Pet door ________ Unscreened Windows ________
Will you have your dog tied up? _______________________________________________________________
Where will your pet sleep during the night: __________________________________________________
In what areas of the house will the dog be allowed? ______________________________________
How many hours per day on average will the pet be left alone?
0-4 ____ 4-6 _____6-8 __________ 8-10 ________ 10-12 ________ over 12 ______
Do you have a relative who would adopt the pet if you, for any reason, become incapable of caring
for him or her? (Note: Noah's B'ark reserves the right to approve this individual)
Yes or No, if yes who? ________________________________________________________________________
Please provide name, address and phone number: ________________________________________________
_______________________________________________________________________________________________
Who is your current or last veterinarian (name,address,phone): ________________________________
_______________________________________________________________________________________________
Will your dog be allowed on the furniture? Yes___________ No ___________
If not, how will you train your dog not to jump on your furniture? ________________________
________________________________________________________________________________________________
Would you allow an inspection of your home/yard? Yes ___________ No __________
How do you plan on housebreaking your new dog? _____________________________________________
(please understand that even dogs that are housebroken will go through an adjustment period)
Do you plan on using a litter pan? _________ If yes, where will it be? ________________________
Are there any reasons that might preclude you from being able to properly care for your new pet?
If yes, please list reasons: ___________________________________________________________________
________________________________________________________________________________________________
Under what conditions would you not keep your new pet?
Move to a place that didn't allow pets _______ Move out of state ____________
Too much hair ____________ Dog grew to big ___________ Chewing _____________
Clawing ____________ Housebreaking problem ___________ Kids ignored pet ___________
New baby ___________ Allergy ___________ Pets didn't get along ________________
Scratches furniture________________ Other _______________________________________
What would you do with your dog if you could not keep it for the aforementioned reasons?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Do you travel a great deal? Yes _________ No ____________
Where does your pet stay when you are on vacation? ____________________________________
Have you ever trained a dog in obedience class? Yes _________ No ____________
Will you be able to live with fur on your furniture, stains on your rugs, a warm body on your bed,
and an animal who may be destructive at times? Yes __________ No ___________
If the dog becomes destructive, what would you do? _______________________________________
How did you hear about this pet adoption?
LATimes_____ DailyBreeze_____ CableTV______ Internet_______ Friend______ PETCO ______
Other__________________________
SOME ADOPTIONS MAY REQUIRE A HOME DELIVERY OF THE PET, I AGREE AND CONSENT TO HAVE A
VOLUNTEER DELIVER MY PET TO MY HOME IN THE EVENT MY APPLICATION IS ACCEPTED,
YES ___________ NO _______________
Signature: _______________________________________________________ Date: __________________
THANK YOU FOR TAKING THE TIME TO COMPLETE THIS APPLICATION.
PLEASE NOTE: Filling out this application DOES NOT guarantee an adoption. We have thoroughly
evaluated all of the animals in our care, and try very hard to match the right pet to the right person
and situation. Adoptions are not on a first come first server basis. We reserve the right not to adopt.
If we do not call or email you within 3-4 days of receiving your application, it means that either:
1. The pet was adopted another applicant, or
2. We felt that the situation presented on the application was not the right situation
for that particular pet.
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