No Yes Have you applied elsewhere for an animal?? *
Where?
Date *
Cat
Dog
What type of pet are you looking for? *
No Yes Do you have a specific pet in mind that is already in the shelter?
First Name *
Last Name *
Spouse/Significant Other/Roommate
Address *
City *
Zip Code *
Length of time at this address *
Home Phone
Cell Phone *
Work Phone
Email Address
Confirm email
Is the dog for you or someone else? *
What is your living situation?
Own Home
Rent Home
Own Condo
Rent Room
Rent Apartment
Live with Parents
Live in Trailer Park
Live with Friends
Rent Duplex
Live with Roommate(s)
Live with in-laws
Other
Please Explain Other
Landlord's Name & Phone Number
No Yes Does Landlord allow animals?
Are there any requirements?
Current or Past Veterinarian and Phone Number
Current or Past Veterinarian and Phone Number (2)
No Yes Did you call your Veterinarian and have them release your records to Noah Project? *
Personal References and Phone 1 *
Personal References and Phone 2 *
Personal References and Phone 3
No Yes Are you planning to sell your home or moving in the near future?
If you have to move, what do you plan to do with your pet(s)? *
No Yes Are you 21 years of age or older?
No Yes Are you a student? *
No Yes Are you employed? *
How many hours will your pet be alone?
How ill you support this pet?
Who in the household will be the animal's primary care giver? *
No Yes Have you or anyone in the household been convicted of animal abuse? *
What were/are the circumstances?
No Yes Do all members of your home know you plan to adopt a pet? *
How many adults live in your home? *
No Yes Do children live in the home? *
How many & What ages?
What is the noise/activity level in your home?
High *
Medium *
Low *
No Yes Is anyone in your household allergic to dogs? *
Please explain the allergy
If someone becomes allergic to your pet, how will you deal with this? *
How much time are you prepared to allow your new bet adjust to your house? *
Are you prepared to spend several weeks or perhaps months waiting for your new pet to adjust to their new environment and for you to adjust with them? *
What is your main reason for wanting to adopt at this time? *
What will your new pet's job be in their new home?
Guard/Security
Companion
Hunter
Couch Warmer
Companion for another pet
Child's Pet
Walking Buddy
Barn Cat
Mouser
Bird Watcher
House Pet
Other
Check all that apply.
No Yes Do you have a specific preferences for your new pet? *
Please list any breed, gender, age, size, and hair coat preferences here:
What is your preferred level of exercise with your pet?
Couch Potato
Short Walks
Hiking/Jogging
Long Runs
Dog Parks
Yard Exercise
Other
Check all that apply
Please list any other personality / characteristics you are looking for:
Do you need a pet that will be adaptable to any of these considerations?
Dogs
Cats
Children
Busy Household
Quiet Household
Adults
Farm Animals
Small Caged Animals
Other
Check all that apply.
What will you feed your pet and how often?
How long will your pet be left alone? *
What shift do you and other adults work? *
Where will your pet be kept during the day?
Kennel / Crate
Bring to Work
In House
Tied Out
In Garage
Barn
Check all that apply.
How will your give your pet exercise? *
No Yes Is your property currently fenced in? *
What kind of fence do you have & how tall is your fence?
Where will your pet be kept during the night?
Kennel / Crate
Tied Out
In House
In Bedroom
In Garage
Barn
Check all that apply
Where will your pet be kept when no one is home?
Kennel / Crate
Tied Out
In House
In Bedroom
In Garage
Barn
Other
In Backyard
Check all that Apply.
What would you do if your pet develops a problem with urinating/defecating in the house? *
What would you do if your pet develops a problem with digging? *
What would you do if your pet develops a problem with excessive barking? *
What would you do if your pet develops a problem with biting / play biting? *
What would you do if your pet develops a problem with destructive chewing or scratching? *
What would you do if your pet develops a problem with shedding excessive hair? *
What would you do if your pet develops a problem with keeping you awake at night? *
What would you do if your pet ruins your favorite clothes? *
What would you do if your pet has separation anxiety? *
What would you do if your pet develops a problem growling at guests? *
What would you do if your pet develops a problem with aggression? *
Bad dog habits that I just cannot tolerate are: *
What would you do if the undesirable behavior continued? *
No Yes Would you willingly attend obedience classes at your own expense? *
How will you keep your pet confined to your property?
Fenced yard
Chained/Tied Out
Trained to Stay
Trolley System
Invisible Fence / Radio Collar
Kept under Supervision
Leash
Other
What is the longest period of time you would let your pet outside unattended? *
Please explain any times your pet may be tied up, outside or inside (crates not included). *
No Yes Do you understand that leaving your pet unattended outside leaves it vulnerable to abuse and theft? *
No Yes Have you ever rehomed an animal to a shelter or a new household? *
Please specify type of animal, breed, spayed/neutered, and how long you owned this animal.
When and what were the circumstances of rehoming that pet?
No Yes Are you able to afford a vet bill of $500 or more for emergency veterinary care? *
How much are you willing to spend on medical bills and maintenance for your new pet per year?
Up to $50
Up to $100
Up to $500
Up to $1,000
Up to $5,000
Whatever it takes
No Yes Have you ever adopted from Noah Project before? *
No Yes Have you ever adopted from the Humane Society or any other rescue before? *
No Yes Are you aware that the potential commitment for your new pet could exceed 15 years? *
No Yes Are you willing to contact Noah Project is you are unhappy with your adoption? *
No Yes May a Noah Project Representative make a follow-up visit? *
Permission, Releases, Understanding & Certifications
I hereby permit Noah Project, or it's appointed representative to call my
references, my neighbors, and anyone it may deem necessary to
determine how I care for or have cared for my companion animals.
I hereby release to Noah Project or its appointed representative all
veterinary records of the animals I own or have owned.
I understand
that, with care, dogs and cats can live 15 to 20 years or more and I am prepared to commit myself to the long-term care and safety of an animal I adopt from Noah Project, and to have the animal neutered, if not already done at the time of the adoption.
I understand that the animal I am applying to adopt my require medical treatment that could result in significant veterinary bills. I will not hold Noah Project accountable for the cost of veterinary treatment this animal may require after adoption.
I understand, if a situation develops where it is necessary to give this animal up, I will promptly notify Noah Project and return the animal to Noah Project.
I certify that all the information in this application is true and correct to the best of my knowledge and belief and I understand that any false information I supply may void the application.
Your Age *
Signature & Date
Clear
