Small Animal Adoption Application « Noah's Ark Society

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Home - Small Animal Adoption Application

Small Animal Adoption Application

Name:*
Date

MM

DD

YYYY
Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
How long have you been at this address? *
Applicant Email*

Enter Email

Confirm Email
Applicant Phone Number:*
Are you adopting for yourself or someone else?:*
Describe in detail the small animal you are looking for:
Will this be your first small animal of this species?:*
- Yes
- No
What kind of pets have you had in the past?:*
Which of these do you still have?:*

(Include age, sex, and breed)
Have they been spayed or neutered?:*
- Yes
- No
- Don’t Know
Are they current on vaccinations?:*
- Yes
- No
- Don’t Know
What happened to the pets you no longer have?:*
Have you ever turned one of your pets into a shelter?:*
- Yes
- No
If YES, please explain:
Have you ever had a pet euthanized?:*
- Yes
- No
If YES, please explain:
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If you have pets, will they adjust to a new animal in the house? Please explain:*
How many adults are in your family?:*
How mayn children in your family? What are their ages?:*
Does any member of your household have an allergy to animals?:*
Where do you live?:*
- House
- Apartment
- Condominium
- Mobile Home
- Other
Do you own or rent your home?:*
- Own
- Rent
If you rent, may we contact the owner to obtain permission for this animal to live in your home?:*
- Yes
- No
Owner's Name and Phone Number:
Who is your veterinarian? What is their phone number?:*
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Does your current veterinarian treat small animals?:*
Is your home small-animal proofed? i.e. electrical cords are covered, there are no chemicals on the floors, plants poisonous to small animals have been removed from the living and playing areas.
Is someone home during the day?:*
How many hours a day will your small animal be alone?:*
How much time will you spend with your small animal daily?:*
What type of enclosure are you planning to use for your small animal? Where will it be located?:*
How much time will your small animal spend in their enclosure and how much time will they be allowed to run around?:*
If you go out of town, who will take care of the small animal?:*
If you move, will you take your small animal with you?:*
Are you willing to care for the small animal and take responsiblity for the animal for the remainder of it's life?:*
Have you ever applied to Noah's Ark Society before to adopt an animal?:*
Have you ever turned an animal over to Noah's Ark Society in the past?:*
Noah's Ark Society requires a home visit. Are you willing to have a Noah's Ark Society representative come to your home?:*
- Yes
- No
Personal Reference #1:*
Reference #1 Address:*

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Reference #1 Email Address:*
Personal Reference #2:*
Reference #2 Address:*

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Reference #2 Email Address:*
How did you find out about Noah's Ark Society?:
Are you aware that small animals such as hamsters can live up to 8 years; guinia pigs can live up to 10 years; and rabbits can live 10 – 15 years?: *
I understand that the standard small animal adoption fee is $75:*
I certify that the above information is true. I also understand that giving false information on this application is grounds for denying an adoption.