Adopt a Rescue Dog

Adopt your new Best Friend

I am applying for the adoption of the dog named (you may enter more than one): *

About the dog you wish to adopt: *

Please provide the desired age and breed. Example: 1-5 years old, Hound mix.

Breed you would not adopt and why: *

Example: "I don't like chihuahas"

Desired Sex:

Male
Female
No Preference

Name *

First

Last

Email *

Confirm Email

Primary Phone: *

Occupation & Employer *

Street Address: *

City: *

Zipcode: *

How long have you lived at this residence? *

Example: 1 year, 3 months

Including you, how many adults (and their relationship to you) and children (including ages) are there in your family? *

Name, Relationship, Age, Adult/Child (List your self as well)

Does anyone in the household have allergies to dogs? *

If yes, who?

(enter none if not applicable)

Do you own or rent? *

Own
Rent

If renting/leasing, are there pet restrictions? *

Select N/A if you own your home.

If you rent, please give the rules governing pets:

Landlord's Name

First

Last

Landlord's Phone Number:

If renting/leasing, we will contact your landlord to ask if fostering animals in your home is acceptable. You will not be able to foster until we receive positive confirmation.

Is everyone in agreement with the decision to adopt a dog? *

Do you have adequate love and attention? *

Please describe your household: *

Active
Noisy
Quiet
Average

Type of fence (if you selected "Other"):

Height of fence (if applicable):

If you don't have a fenced in yard, do you agree to keep your dog on a leash AT ALL TIMES when outside? *

Select N/A if you have a fenced in yard.

Please list the other animals (dogs, cats, other) living in the household along with their breed, gender, and ages and whether they are spayed or neutered: *

Example: Dog, Hound, Male, 3yrs, Neutered (or none if you do not have any pets)

Do you agree to provide regular health care by a Licensed Veterinarian? *

Select N/A if you have a fenced in yard.

Are all pets up to date on vaccines? *

If no, please explain the circumstances:

Do you have a regular veterinarian? *

If you do not currently own a pet, please put select N/A

Veterinarian's Name: *

Please provide the name and phone number for your current (or past) veterinarian.

Clinic Address: *

Please provide the name and phone number for your current (or past) veterinarian.

Veterinarian Phone *

Personal Reference *

First

Last

Please provide the name and phone number for a personal reference. The personal reference may include close friends, dog trainers, neighbors, or someone who knows of your experience with dogs. Please use no more than ONE relative.

Personal Reference Phone *

Number of hours (average) dog will spend alone? *

Who will have primary responsibility for this dog's daily care? *

Who will have financial responsibility for this dog? *

Do you agree to keep the dog as an indoor dog? *

Select N/A if you have a fenced in yard.

Do you agree to contact Noah's Rescue if you can no longer keep this dog? *

Are you willing to let a representative of Noah's Rescue visit your home by appointment? *

How did you hear about Noah's Rescue? *

Would you be interested in fostering? *

Yes - please send me information
No

Select N/A if you have a fenced in yard.

Have you ever surrendered a pet? *

If yes, please explain the circumstances:

Example: Dog, Hound, Male, 3yrs, Neutered (or none if you do not have any pets)

How do you discipline your pets and why? *

If you do not currently have a pet, please describe past experience or how you think you would do so.

How would you describe your level of experience with dogs? (Check all that apply): *

Never had a dog
Had a childhood pet dog
Had one or more dogs as an adult
Have experience with high-energy/working breeds
Have experience working at a boarding kennel/resort/pet sitting service, etc.
Have experience working with behavioral problems with a personal dog
Have experience working in a veterinary hospital
I am a professional dog trainer
Have previous foster/rescue experience

List experience with specific breeds (or none if not applicable): *

Where will this dog be when someone is home? *

Where will this dog be when alone? *

Where will this dog sleep at night? *

What situations do you feel unprepared for? (Select all that apply) *

This is to help us place you with the right dog, and provide assistance with any needs/questions you may have.

If you selected "Other" - please describe the situations you feel unprepared for:

Anything else you would like us to know to hep match you with the right rescue dog?

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