Adoption Application

Adoption Application
Please fill out the application form honestly and completely. We cannot process incomplete applications. Though the application is one step in our adoption process, it is the first opportunity we have to get to know you and it is an important part of our being able to make the best adoption match. YOU MUST BE 21 YEARS OF AGE TO APPLY.
Applicant Information
Applicant Name

First NameLast Name
Name of the pet you are interested in adopting:*
How did you hear about NCAW?*
Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Occupation*
Home Information
HouseApartmentTownhouseDuplexMobile HomeOther
OwnRent
YesNoOther
YesNo
YesNo
If renting, please provide your landlord's name and phone number. We cannot process your application without this information.*
Describe your yard and fence:*
Household Information
Tell us about the members in your household. List all household members including their age, sex and relationship to you.*
Example: Mary, 12 years old, daughter
YesNoI have not told them yet
YesNo
Other Pets
YesNo
What other pets do you currently own? Please be specific with AGE, SEX and BREED.*
Example: Fido, 5 years, male, labrador retriever mix
YesNo
If you currently have another pet that is not spayed or neutered, please tell us why:*
Please supply the name and phone number of your current veterinarian:*
YesNo
Please tell us about pets you have owned in the past:*
Have you ever had to rehome a pet? If so, please explain the circumstances:*
Additional Information
Why do you want to adopt a pet?*
How many hours each day will your new pet be home alone?*
Where will your pet be kept at night or when you leave your home?*
YesNo
If yes, who will provide for your pet(s) while you are away?*
What traits would you find unacceptable in your new pet?*
What steps would you take to correct unwanted behavior?*
NoNot sureYes
Describe any experience you have had with obedience training or with medical or behavioral issues.*
What kind of activities do you or will you do with your pets for fun and/or exercise?*
What restrictions would you place on your dog's interaction with children? What restrictions would you place on a child's interactions with your dog? *
What circumstances would prevent you from keeping a pet for the rest of its life?*
YesNoUnsure
Please supply the name and phone number of an employer, friend or someone NOT related to you that can attest to your character.*
Please provide any additional information you would like us to know about your home, family and why you are applying for a rescue dog:
Terms & Conditions

Adopter Agrees to the Following Terms and Conditions
Yes, I agree
Yes, I agree
Applicant understands and agrees that NCAW makes no guarantees or warranties regarding the health, behavior and/or temperament of this animal. Adopter accepts full responsibility for any risks associated with owning this animal and hereby forever releases NCAW and its agents from any and all liability arising out of Adopter’s ownership and possession of this animal including, but not limited to, any claim for damages to persons or property caused by this animal. NCAW advises that any interaction between pets and children are to be closely supervised.*

I Agree
$75 Minimum Adoption Fee

Website: ncanimalwelfare.org

Email: ncanimalwelfare@gmail.com
Signature*

Powered by Jotform SignClear
Date*

MonthDayYear
Date
Should be Empty:

Adoption Application

Applicant Information

Home Information

Household Information

Other Pets

Additional Information

Terms & Conditions