Canine Adoption Application

Thank you for your interest in adopting one of our canines! Our adoption process includes an approved application, reference checks, and a meet & greet. A home visit may also be required. Please make sure the application is completely filled out before submitting.

If you have any questions at all, please email adopt@friendsofnoah-wi.org or call us at 608-774-3402 and you will be put in touch with the Canine Adoption Manager.

**Please note, due to Wisconsin state regulations, all animals being adopted out of state must be accompanied by a CVI (Certificate of Veterinary Insurance). Out-of-state adoptions will potentially take longer. Unfortunately, due to the added cost of the CVI, adoption fees will increase by $50 to help us recoup part of the cost. Thank you for understanding.

Are you interested in a specific animal?

if yes, please name

**** PLEASE NOTE: There may be other people filling out an application for this animal. The process of adoption is not on a first-come, first-served process. We will match to the best home for the animal. Therefore, ALL applications will be considered. Our volunteers try their best to respond to all applicants; however, due to the sheer volume of applications received it is not always possible.

Section 1: Personal Information

Applicant Name*

First NameMiddle NameLast NameSuffix

Date of Birth *

Date

Nickname (if applicable)

Email*

example@example.com

Phone (Best Number to Reach You)*

Area Code / Phone Number

Phone Number (Best to Reach You) *

Area CodePhone Number

Co-Applicant Name (if applicable):

First NameMiddle NameLast NameSuffix

Date of Birth

Date

Nickname (if applicable)

Email

example@example.com

Phone Number

Area Code / Number

Phone Number (Best # to Reach You)

Area CodePhone Number

Address*

Street Address 1

Street Address 2

CityState

Postal Code

Please select your county of residence from the drop down menu. If your county is NOT listed, select OTHER and type in below. *

If OTHER was selected above, please type in your county of residence:

County

Section 2: Residency Information

Please indicate which best describes your dwelling*

	Yes	No
Do you own your own home?
Do you rent your home?
If renting, does your lease agreement/landlord permit dogs?
Would you consent to a PRE-ADOPTION home visit by Friends of Noah — WI personnel upon request?
Would you consent to a POST-ADOPTION home visit by Friends of Noah — WI personnel upon request??

How long have you been at your present address

YearsMonths

** If you rent, you must attach a written consent form from your landlord along with their mailing and phone contact information. This documentation must be submitted with your application.

Section 3: People

Are there other adults living in the household? If so, please list their names and date of birth.

first, middle initial and last name, date of birth

Are there children living in the household or regular visitors to the home? If so, please list their names and ages.

first and last name, age

	Yes	No
Is anyone in the home allergic to dogs?
Is anyone in the home afraid of dogs?

Section 4: Animals in Your Household

List all other pets (dogs or cats) living in the home.

	Pet Name	Age	Breed	Length of Ownershiop	Gender	Last Vaccinated Date
Pet 1
Pet 2
Pet 3
Pet 4
Pet 5

Please tell us about pets you have owned in the past:

Please let us know where the pet(s) is now. If it is deceased, please include the cause of death:

Have you surrendered any pets to an animal shelter or rescue? *

If yes, what were the circumstances of surrender? If no, please skip to the next question.

How long do you plan to keep this dog?

Who will have primary care-taking responsibilities for this dog:

What brand and type of dog food do you plan to feed this dog?

Do you have a fenced in yard?

If yes, what type of fencing

Will the dog be an inside or an outside dog?

In the houseOutdoors

Percentage of time dog will be kept inside and when?

Percentage of time dog will be kept outside and when?

In what room in the house will the dog sleep?

How many hours a day will the dog be alone?

When alone, where will the dog stay?

If other, please describe.

Will you be attending training classes with your dog?

If yes, where?

If you intend to train the dog yourself, what experience have you had in doing so and what types of training have you used in the past? Please explain in detail.

What are the minimum training commands you expect to teach your dog?

Have you ever house-broken a dog/puppy before?

If so, describe your training methods:

How do you plan to exercise your dog, and how often? Be specific.

A rescue animal may have some initial adjustment problems at first. Are you willing to provide extra attention and/or training, if needed?

If yes, how long will you give the dog to adjust?

Please explain how you will handle any issues that arise:

Are there any types of adjustment/transitional/behavioral issues that you absolutely will NOT tolerate for ANY length of time?

Please list in detail what you expect to provide in the way of medical care for this animal on a continuing basis:*

Section 5: References

Your Veterinarian (most recently used if more than one)*

Vet Clinic / Hospital

Vet Name

City

State

Email

example@example.com

Phone

Area Code / Number

Phone Number

Area CodePhone Number

Phone Number

Area Code / Number

Personal Reference:

Please list a personal reference who meets the following criteria:

Not family member or directly related to you
Is knowledgeable about and familiar with your care of animals
Is not the veterinarian listed above

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area Code / Number

Phone Number

Area CodePhone Number

Email

example@example.com

Affiliation

(see above examples)

Second reference contact

Is there anything you would like to comment on regarding pre-adoption or post-adoption visits?

Do you have any other comments you would like to make in relation to adopting this pet?

• All members of the household where the dog will reside upon adoption are required to visit the foster home or designated location when meeting the dog. An adoption cannot take place until the dog and the foster guardian meet all of the individuals.

• All adoptions require an adoption fee to be paid by the adopter. Adoption fees include any applicable state/county taxes.

• Out-of-state adoptions will incur an additional $50 for the required CVI (Certificate of Veterinary Insurance).

• No income is gained from animal adoption fees. The amount charged is, in fact, LESS than what the total costs are for veterinary expenses, food, and other supplies. It does cover all veterinary work, vaccinations, and health care up to the day of adoption.

• At times we are not aware of the complete health and behavior history of the animal prior to coming to our care. Therefore, more routine health care may be required, and is the responsibility of the new owner to make appointments and pay for the expenses of the future care of this animal.

Section 6: Electronic Signature

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully.

I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in the forfeiture of any FRIENDS OF NOAH animal adopted by me.

I certify that the above information is correct, and I understand that the information will be verified.

I understand that by submitting this form electronically, I agree to release and covenant to hold harmless FRIENDS OF NOAH and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the adopted dog.

I accept full responsibility for the dog's actions at all times, and release FRIENDS OF NOAH from any liabilities or damages that may be incurred because of adopting such dog.

I agree to have FRIENDS OF NOAH complete reference call checks and conduct a home visit inspection to be able to approve my adoption application.

I agree that if I'm unable to keep the adopted dog anymore that I will return the dog to FRIENDS OF NOAH and try to give FRIENDS OF NOAH a 2 week period to try and find a suitable foster for the dog.

I agree that by submitting this application, I am electronically signing the application.

I,

Given Name(s)*

Last Name*

, solemly declare that the information I have provided is true and the document that I am submitting in support of my application are genuine and have not been altered in any way.

City

CANINE ADOPTION APPLICATION – Dog or Puppy