Pet Interested In: *
Today's Date: ... *
Pet ownership is a serious responsibility. This policy of the adoption group is to assure that each person who adopts a pet is aware of the responsibility, and that each is capable and willing to accept that responsibility morally, physically, and financially. It is quite true that not everyone who desires to own a pet should have a pet.
The following questionnaire has been designed to aid both you and the adoption group in decidingif you and/or your family is indeed at this moment adequately prepared to assume the type of responsible ownership which we are endeavoring to assure for our adoption animals.
Please be sure to answer all questions and feel free to add your own comments. If a questiondoes not apply write N/A.
Occupation
Spouse
If this relationship were to change, with whom would the pet remain?
Do all adults in your household know you plan to adopt? Yes No
Who will be primarily responsible for the care of the pets?
What are your reasons for adopting a pet? A companion for you A companion for your pet Spouse Children Gift Other Guard dog (for home or business)
Please explain your above answer:
If you chose as a guard dog for a business, what type of business is it? Where is the business located?
Do you... Own Rent
If rent, do you rent a... House Condo Apartment
If rent, are pets allowed? Yes No
Length of residency?
Breed
Age
Hair Long Short
Sex Male Female
Color
Personality
This animal will be Indoor Only Mostly Indoor Mostly Outdoor
If you answered indoor only, please describe what outdoor access the pet will have (when will it go out, etc.)
If you have children, please list their ages:
Have your children ever been around cats/dogs? Yes No
Has a cat/dog ever bit your child? Yes No
Do your current pets like cats/dogs? Yes No
Have you every bred a cat/dog? Yes No
If yes,did you breed for: Fun Show Profit Accidentally Happened
If you presently own a dog has it been neutered/spayed? Yes No
If no, why not?
Do you plan on breeding your new dog? Yes No
Has your cat/dog been vaccinated? Yes No
If so, date of the last vaccine?
At what age should a dog be altered (spayed/neutered)? 4 months 6 months 1 year After first heat After one litter
Spayed/Neutered? Yes No
Inside or outside pet? Yes No
Do you still have this pet? Yes No
If not, why?
In regards to the above questions, what happened to your pet(s)? Hit by car Old Age Died of disease Gave Away Gave to Shelter Still own the pet
What outside space is available for the dog?
Do you have a fenced yard? Yes No
If yes, how high is it?
Type of fencing Chain Link Brick Wall Wood Other Locks on gates?
Other provided living areas: Garage Balcony Unfenced Yard Kennel Run Other
Do you have a: Balcony Pool Pet Door Unscreened Windows
Will you have your dog tied up?
Where will your pet sleep during the night:
In what areas of the house will the dog be allowed?
How many hours per day on average will the pet be left alone? 0-4 4-6 6-8 8-10 10-12 over 12
Do you have a relative who would adopt the pet if you, for any reason, become incapable of caring for him or her? (Note: Noah's Bark reserves the right to approve this individual) Yes No
If yes, who?
Please provide name, address and phone number:
Who is your current or last veterinarian (name,address,phone):
Will your dog be allowed on the furniture? Yes No
If not, how will you train your dog not to jump on your furniture?
Would you allow an inspection of your home/yard? Yes No
How do you plan on housebreaking your new dog?
Do you plan on using a litter pan? Yes No
If yes, where will it be?
Are there any reasons that might preclude you from being able to properly care for your new pet? Yes No
If yes, please list reasons:
Under what conditions would you not keep your new pet? Move to a place that didn't allow pets Move out of state Too much hair Dog grew to big Chewing Clawing Housebreaking problem Kids ignored pet New baby Allergy Pets didn't get along Scratches furniture Other
What would you do with your dog if you could not keep it for the aforementioned reasons?
Do you travel a great deal Yes No
Where does your pet stay when you are on vacation?
Have you ever trained a dog in obedience class? Yes No
Will you be able to live with fur on your furniture, stains on your rugs, a warm body on your bed, and an animal who may be destructive at times? Yes No
If the dog becomes destructive, what would you do?
How did you hear about this pet adoption? LATimes DailyBreeze CableTV Internet Friend PETCO Other
SOME ADOPTIONS MAY REQUIRE A HOME DELIVERY OF THE PET, I AGREE AND CONSENT TO HAVE A VOLUNTEER DELIVER MY PET TO MY HOME IN THE EVENT MY APPLICATION IS ACCEPTED, Yes No
Type Your Name
Today's Date: ...
THANK YOU FOR TAKING THE TIME TO COMPLETE THIS APPLICATION.
PLEASE NOTE: Filling out this application DOES NOT guarantee an adoption. We have thoroughly
evaluated all of the animals in our care, and try very hard to match the right pet to the right person
and situation. Adoptions are not on a first come first server basis. We reserve the right not to adopt.
If we do not call or email you within 3-4 days of receiving your application, it means that either:
1. The pet was adopted another applicant, or
2. We felt that the situation presented on the application was not the right situation
for that particular pet.
Your application has been successfully submitted!
