DOG AND PUPPY ADOPTION APPLICATION

DOG AND PUPPY ADOPTION APPLICATION (2019)

Noah's Ark Rescue Project and Sanctuary
Approval Status
App Processor
Approval Status Comments
Name(s) of the pet(s) you are interested in adopting:*
I understand that if ANY information is found to be FALSE or INCOMPLETE, my application will be DENIED without notification.*

Yes
I agree to allow NARPS to obtain any and all pertinent information regarding my housing situation and care of my animals (if applicable).*

Yes
Personal Information
Date of Application*

MonthDayYear
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Age?*
Gender?*
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number*

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
Can you provide proof of residence? (Driver's License, ID, etc.)*

YesNoOther
Partner/Spouse's Name:*
Age?*
Gender?*
Current and Past Pets

Please fill out to appropriately describe the CURRENT pets in/at your home.*

Rows	Dog	Cat	Rabbit	Potbellied Pig	Bird	Horse	Cow	Goat	Other	NO PETS
Pet #1
Pet #2
Pet #3
Pet #4
Pet #5
Pet #6
Pet #7
Pet #8

For the current animal(s) residing in/at your home indicated above, please list for each animal the species, breed, and age..*
Are all your animals Spayed/Neutered?*

YesNoNo, Medical ReasonSome of my pets are altered and some are notI do not currently have any pets
If all your animals are not altered please explain why. If you do not have any animals currently please leave this section blank.
Please tell us about the animals you have owned in the past, who are no longer with you.*
Where will the pet mainly be residing?*

Inside HomeOutsideGarageBarnOther
When inside, how do you plan to keep your pet? Check all that apply.*

Free inside houseConfined to crateInside a closed roomGarageCrated only when no one is homeOther
When outside, how do you plan to keep your pet? Check all that apply:*

N/A, indoors onlyTie out chainGaragePatio areaInvisible fenceFenced yardOutside dog runLeash and regular walksLoose in yard unattendedOther
Where will your pet be kept during the day when you are not home/ when you are home?*
Where will your pet be kept at night?*
How many of the animals listed above reside INSIDE your home on a permanent or semipermanent basis? *
Do any of your pets have strong DISLIKES? I.E.: Male dog who strongly dislikes other male dogs.*
Do any of your pets have strong LIKES? I.E.: Male dog who prefers and likes smaller dogs, verse dogs his own size or larger.*
Training and Behavior
Which of the following behaviors or characteristics present a problem for you? Check all that apply*

Jumping on furnitureBarking/howlingChewing on shoes/furnitureJumping on peopleSheddingDiggingPoor leash mannersAccidents in the houseOther
How do you plan to handle these issues should they become an issue?*
Will you consider taking your dog to training classes, if need be?*
Home Information
Do you Own or Rent your home?*

OwnRent
What type of home do you have?*

Single Family HomeCondoFarmMobileApartmentOther
How long at your current address?*
If less than 2 years, what was your previous address?*
If renting, please include landlord's information; name, address, phone number, email address. *
If you rent, does your lease allow pets?*

YesNoDon't knowN/A I own my home
How many pets are allowed?
Breed or Size/Weight Restrictions?
Would you allow a home check to be performed by a NARPS staff member or volunteer?*

YesNo
Please describe general home information; city, suburbs, rural? house size? acreage? stairs/no stairs? yard size? ability to separate pets if necessary? close to neighbors? neighbors have pets?*
Fenced in yard?*

No fenced in yardElectric/underground fenceFully enclosed/fenced in yard4ft fencing (chain link, privacy, mesh, etc.)6ft fencing (chain link, privacy, mesh, etc.)Other
Do you plan on moving in the foreseeable future? If so, where will you move, when and why?*
Family Information

Please fill out to appropriately describe those who reside in your home. *

Rows	Under 1yr old	1 - 4yrs old	5 - 7yrs old	8 -11yrs old	12 - 14yrs old	14 -18yrs old	18 - 25 yrs old	26 - 99 yrs old
Family Member #1
Family Member #2
Family Member #3
Family Member #4
Family Member #5
Family Member #6
Family Member #7
Family Member #7

Please list the names, ages, genders, and relationships of the people in your household.*
Are ALL members of your household aware of and in agreement with this adoption? If not, please list who is not in favor of the adoption and the nature of their concern or objection.*
General Adoption Information and Preferences
Have you ever been approved to adopt from a shelter or another rescue organization?*

No, I have never appliedNo, I have been deniedNo, I have applied and never heard backYes, I have been Approved and adoptedYes, I was approved but I did not adoptOther
If you have been approved for another rescue please list the rescue name.
Name of the Rescue
Why do you wish to adopt this pet? Check all that apply:*

Love animals, want to help a pet in needCompanionshipMy children will learn to be responsible for/care for another creatureWant to breedLooking for guard dog for home/propertyCompanion for another petOutside petThe animal is so cute I just can't leave it behindFeel sorry for the animalPet passed away and ready to welcome new family memberBeen looking for a specific breed/type and waiting to find one available to adoptOther
What is your preferred level of exercise with the dog? Check all that apply:*

Couch potatoYard exerciseShort walksVigorous walksHiking/joggingLong runs/strenuous exerciseOther
What strong preference do you have in a dog or cat? Check all that apply.*

FemaleMaleLong hairShort hairNon-shed or hypoallergenicOther
Breed preference?
Size/Weight preference?
Age preference?*

Puppy (8 weeks to 6 months)Mature puppy (7 months to 1 year)Young adult (1 year to 3 years)Adult (3 years to 6 years)Senior (7 years to 10 years)Golden Years Senior (11 years & older)Other
Do you have a second or third choice among the pets available to you today?*
Vet Care

***Please ensure to call your vet and approve us to view your records***
Who is your current veterinarian? Name, address, and phone number. If you owned an animal within the past 5 years *
Are your pets all current and up to date on routine care?*

YesNoOther
Are your pets all current and up to date on their annual vaccinations, INCLUDING their rabies shots? *

YesNoOther
Would you allow us to speak with your vet to obtain information on the health care of your pets?*

YesNo
What do you consider routine care for your pets' wellbeing?*
Would you be getting Pet Insurance for your adopted pet(s)?*

YesNoMaybe
Employment Information
Are you currently (check all that apply):*

Employed full time (30 or more Hours a week)RetiredSemi-retiredStudentEmployed part time (Under 30 hours)UnemployedOther
If employed, how many hours per week do you work on average?
If employed, name of employer, position/occupation, and length of time with employer:*
If a student, where?
Spouse/partner occupation:
Spouse/partner employer:
Spouse/partner length of time with employer:
How many hours per week does your spouse/partner work on average?
References

3 references are required and references should be UNRELATED to you. You must list references even if you currently don't own pets or if you have not previously owned pets. ALSO, PLEASE LET THEM KNOW THEY ARE LISTED AS YOUR REFERENCES AND TO EXPECT A CALL FROM ONE OF OUR VOLUNTEERS.
Please provide the name and phone number of your FIRST reference.*
Please provide the name and phone number of your SECOND reference.*
Please provide the name and phone number of your THIRD reference.*
Responsibility
Who will be primarily responsible for the care of the pet? How old?*
If your pet(s) were to survive you, what would happen to them? Who would take responsibility for them? Is the person listed aware of this?*
Have you ever taken a pet or pets to the pound or shelter? *

YesNoOther
If you move in the future, what will you do with the pet(s) you plan to adopt?*
What would cause you to return the adopted pet to us at some time in the future? (Check all that apply):*

Can't housebreak the petPet chews on furniture or is destructivePet bites somoneNew pet doesn't get along with exiting pet(s)Changed my mind about caring for petPet proves to be too much on top of caring for childrenDivorce, death of spouse/partnerFound out I'm not a "dog/cat" personPet develops a serious medical condition that I can't afford to treatToo much energy, hard to controlCan't afford the petChange in relationship, new love interest doesn't like petsGive birth to new baby, fear that dog/cat will harm him or herKids go away to school, don't want to care for pet any longerLife changes such as new jobOther
If you are no longer able to keep the animal(s) you adopt, do you agree that you must return them to NARPS?*

YesNo
Are you willing to abide to Pennsylvania state law regarding animal care and containment?*
Thank you for taking the time to complete this lengthy, in-depth adoption application. We hope you understand that we do so only to better serve those lives in our care and to ensure successful adoptions! We appreciate your complete honesty and transparency in filling out our adoption application and forms! NARPS will do its best to review all applications in a timely fashion and keep interested parties fully informed of our decisions.
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DOG AND PUPPY ADOPTION APPLICATION (2019)

Personal Information

Current and Past Pets

Training and Behavior

Home Information

Family Information

General Adoption Information and Preferences

Vet Care

Employment Information

References

Responsibility