NOAH'S ARK BAYOU SANCTUARY ANIMAL RESCUE PET ADOPTION APPLICATION Please print all information clearly. If we can't read it, we can't process it. Thank you. By completing this form, you will assist us in establishing that you and your family are ready for the responsibilities of pet ownership. If you qualify and are accepted, we will contact you via email. Please be sure to check your spam folder also for a message from us. NAME:_____________________________________ WHERE EMPLOYED: ____________________________ HOME ADDRESS:____________________________ HOW LONG EMPLOYED: ________________________ ____________________________ _______________WORKPHONE: __________________________________ CITY:__________________ STATE:____ ZIP:______ HOW LONG AT ADDRESS_______________________ HOME PHONE:_______________________________ CELL PHONE:__________________________________ EMAIL ADDRESS:___________________________________________________________________________ NAME OF PET(S) YOU ARE INTERESTED IN ADOPTING: ________________________________________ 1. Why do you want to adopt at this time?__________________________________________________________ ________________________________________________________________________________________ 2. What preparations have you made (or will make) for your new pet?____________________________________ ________________________________________________________________________________________ 3. Do you want this dog as a _watchdog _companion/family member _child's pet _hunting dog _guard dog _fighting dog _ outside dog _company for other pet _gift _ other _____________________________________ _________________________________________________________________________________________ 4. Who will have primary responsibility for your new pet?_____________________________________________ _________________________________________________________________________________________ 5. Have all adults in the household been consulted and do they agree to this adoption? _Yes _No 6. Are you financially able to take care of an ill or injured pet (Which may cost hundreds of dollars)? _Yes _No 7. Please describe the extent of care that you are willing to provide should your dog have special needs now or in the future: _______________________________________________________________________________ 8. Do you live in a _house _apartment _townhouse _condo _other_______________________ Do you _rent _own 9. If renting, do you have permission to keep pets? _Yes _No Landlord's name: ___________________________ Phone number: ____________________________ 10. If a pet deposit is required, has it been paid? _Yes _No 11. Will the adoption of this pet comply with your subdivision/condo/apartment regulations? _Yes _No 12. Do you have a yard? _Yes _No If yes, please describe _no fencing _partially fenced _ completely fenced. If fenced, type of fencing? _____________Height of fencing_____ Condition of fence _new _older but in good shape _ needs some repair _ needs replaced (NOTE: A picture may be required of your yard) 13. Have you ever owned a pet? _Yes _No If yes, please list your past and current pets below: Pet Name Sex Age Pet Type Breed Size Living Passed _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ If there are additional pets, please _ check here and list them on the back of this form. 14. Have you ever had to give up an animal for any reason? _Yes _No If yes, what happened to the pet? Did you _take the pet to a shelter _found the animal a new home _other? If other, what did you do? _______________ ________________________________________________________________________________________ 15. During the last two years, have you _lost a pet (runaway pet) _had one poisoned _was killed by a vehicle, __ stolen _died from disease? If so, what disease did the animals die from? ____________________________________________________________________________________________________________ 16. Are all pets in the household current on their vaccinations? _Yes _No (NOTE: For cats, feline distemper, leukemia, rabies. For dogs, canine distemper, hepatitis, parvovirus, rabies.) 17. Are all your pets spayed or neutered? __Yes __No 18. Are you using heartworm preventative __Yes __No If yes, what kind? _______________________________ 19. Please describe you personal knowledge of the cause and prevention of heartworms: _____________________ _________________________________________________________________________________________ _________________________________________________________________________________________ 20. Please provide a list of all the veterinarians or clinics that have seen your pet (s): Name:___________________________ Phone:____________________ Address:_______________________ Name:___________________________ Phone:____________________ Address:_______________________ Name:___________________________ Phone:____________________ Address:_______________________ 21. Do you have children? __Yes __No If yes, what are their ages? ______________________________________ 22. If you have children, have they been taught how to treat animals with respect and kindness? __Yes __No 23. Do any members in your home have any known pet allergies? __Yes __No If yes, allergic to what _________ 24. Do you plan to take this pet to formal training classes? __Yes __No If yes, what kind?___________________ Where will this training take place? _____________________ If no, how will you home train your new pet? ________________________________________________________________________________________ 25. Where will you exercise this pet? _________________________________ How often? __________________ 26. How will you transport this pet? _______________________________________________________________ 27. If crated or kenneled, how many hours per day? _________ How big is the crate or kennel? _______________ 28. You may need to house train a new puppy or dog. What is your method of house training? ________________ ________________________________________________________________________________________ 29. Can you invest the time and effort to allow this pet to adjust to its new home? __Yes __No How long are you willing to invest in this?__________________________ Have you ever adopted a rescue before? __Yes __No 30. What do you consider valid reasons that you would give up a pet? (Mark all that apply.) __moving __fleas __destructive __biting __grew too large __chewing __difficulty housebreaking __too rough with children __vet bills __barking too much __too active __digging __having a baby __other ________________________ 31. What will you do if this pet demonstrates the following behaviors? Digging____________________________ Chewing ____________________________Not getting along with other pets __________________________ Difficulty adjusting to household _____________________________ How long would you give this pet to change its behavior with additional training? ________________Would you seek this training __Yes __No 32. If needed how would you discipline your pet?____________________________________________________ _________________________________________________________________________________________ 33. How many hours in a day will this pet be left alone?_______________________________________________ 34. Where will this pet be kept when left alone? __outside __crated __free roam of house __enclosed kitchen or laundry room __garage __ other. If other, please explain:___________________________________________ 35. How many hours in a 24 hour period would this pet spend indoors? ______________ outdoors?____________ 36. Where will this pet sleep at night? ( Mark all that apply) __ crate __kitchen or laundry room __outside __garage __master bedroom or child’s room __it’s own bed __yours or child’s bed __other_______________ 37. Where will this pet be kept when you go on vacation? _____________________________________________ 38. If this pet were lost, what would you do? ________________________________________________________ 39. Do you realize that dogs and cats can live as long as 15 years or more? __Yes __No Are you willing to accept responsibility for a living creature for that long? __Yes __No 40. Would you object to a home visit by NABS? __Yes __No I certify that the above information is true and that false information may result in nullifying this adoption. Signature:________________________________________________ Date: ______________________________ No animal will be adopted to prospective owners who mislead or fail to provide accurate information on the adoption application and/or the adoption contract. N.A.B.S. doe not adopt pets on the first come, first served basis. All applications will be screened by N.A.B.S. to determine the most suitable match for both you and the animal. N.A.B.S. reserves the right to refuse to adopt to anyone. COUNTY ROAD 210 AT AUSTIN BAYOU P O BOX 307 LIVERPOOL, TX 77577 (281) 330-5238 FAX 1-(601) 300-5238 NABSTX2004@AOL.COM WWW.NABS-TX.COM