Noah's Ark SPCA
Animal Shelter
ADOPTION APPLICATION
What is the name of the pet you wish to adopt
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Adopter Information
Name
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First Name
Last Name
Address
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Street Address
City
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State Province
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Postal Zip Code
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Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
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example@example.com
Driver's License Number/Government Issued ID:
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Age
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Employment
Are you currently (check all that apply):
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Employed Full Time
Employed Part Time
Unemployed
Retired
Student
Other
Line of work
Job Title
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Employer
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Family Information
Please list the names, age, and relation to you of ALL people living in the household.
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Home Information
Do you rent or own your home?
Own
Rent
If you Rent, what if your Landlord's name
Landlord's phone number:
Please enter a valid phone number.
Format: (000) 000-0000.
Home Description:
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House
Condo / Townhouse
Apartment
Travel Trailer
Do you have a fenced in yard?
If Yes, what kind of fence and how high?
Adoption Information:
What is the reason you wish to adopt this animal?
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Family Pet - I want a pet for my family/children
Companionship - I want a loving pet to be my companion
Emotional Support - I want a pet for comfort and emotional well-being
For My Other Pet - I want a companion for my current pet
Working/Service Role - I'm adopting for a specific role (e.g., farm dog, therapy pet, search & rescue)
Property Protection - Guard dog for property
Active Lifestyle - I want a pet to join me in outdoor activities and exercise
Gift - for Friend/Family
Other
If Gift for someone, who is the person?
Veterinary Care
Are you committed to providing regular veterinary care for your adopted pet?
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yes
no
Do you agree to schedule routine wellness exams, including vaccinations and preventive care?
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Yes
No
Can you financially commit to veterinary expenses of at least $500 per year foryour pet's healthcare?
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Yes
No
Current or past veterinarian: (Name & Phone Number):
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Do you authorize a representative from Noah's Ark SPCA to contact your veterinarian for information regarding the health and care of your current or previous pets?
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Yes
No
Please list all pets you currently own or have owned in the past, including those you no longer have. If you no longer have them, include reason why.
Do your current pets wear ID tags?
yes
no
N/A - do not have a current pet
Are your current pets microchipped?
yes
no
N/A - do not have a current pet
Are your current pets' vaccinations up to date?
yes
no
N/A - Do not have a current pet
Are your current pets on heartworm prevention:
yes
no
N/A - Do not have a current pet
If Yes, which heartworm prevention do you use?
If No on any of the above questions please state why:
Home Routine
Which hours during the day will your pet routinely be home alone?
Please list the approximate hours your pet will home alone. Ex: 8am-4pm, if someone is home all day, write "None."
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Do you plan on allowing your pet inside the home?
yes
no
Where will your pet be kept during the day? (select all that apply)
Free roam inside home
Inside a closed room
Confined in a crate
Designated indoor area (e.g., playpen, gates section)
In fenced yard
Outdoor run or kennel
At a dog daycare
With pet sitter or family
Other
When/if outside, how do you plan to keep your pet? (Select all that apply)
NA, indoor only
Garage/Patio area
Invisible Fence
Outside dog run
Leash/regular walks
Tie out
Other
Where Will Your Pet Sleep at Night? (Select all that apply)
Free roam inside home
Designated indoor area (e.g., playpen, gated section)
In crate
On bed
Dog bed
Fenced yard
Outdoor run/kennel
Other
Training and Behavior
How Do You Plan to Handle Undesirable Behaviors? (Select all that apply)
Redirecting behavior with appropriate toys or activities
Providing positive reinforcement (treats, praise, rewards)
Crate training when necessary
Increased exercise and mental stimulation
Consistent training and commands
Seeking professional training or behavior support
Using deterrents (e.g., bitter spray for chewing)
Ignoring attention-seeking behaviors (e.g., excessive barking)
Other
Have You Handled Behavioral Challenges with Pets Before?
Yes, I have successfully addressed behavioral issues in past pets
Yes, but I struggled and needed professional help
No, but I am willing to learn and seek guidance if needed
No, I have never had a pet with behavioral issues
Commitment & Future Planning
Who will be primarily responsible for the care of the pet? How old is this person?
Have You Ever Had to Surrender a Pet?
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No, I have never surrendered a pet
Yes, I have surrendered a pet before
If You Have Surrendered a Pet, What Did You Learn from the Experience?
I realized I needed to better evaluate my lifestyle before adopting
I learned the importance of training and behavior management
I now understand the financial or time commitment required for pet care
I discovered the importance of choosing the right pet for my home and family
Other
Type a How long do you plan to keep the pet you are adopting?
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For their entire lifetime
Until circumstance change
I'm unsure
If you were to move in the future, what would you do with the pet? (Select all that apply)
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Take them with me no matter what
Ensure my new home is pet-friendly before moving
Rehome them if necessary
Surrender them to a shelter or rescue
Other
If something were to happen to you, who or what (e.g., a designated caregiver, legal will, or trust) would ensure your pet is cared for and not taken to a shelter?
If you can no longer provide your pet a home do you agree to return he or she to Noah's Ark? (if possible, it is possible that Noah's Ark would not be able to arrange transport to pick up an out of state pet, in this instance we would then recommend local help).
Yes
No
Any other information you would like us to consider? Put N/A if none.
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Signature
Adopter Name Printed
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Date
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Month
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Day
Year
Date
I have read and agree to the terms above.
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Agree
Type your full legal name as your electronic signature.
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Submit
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