N.A.R.C. Adoption App

Full Name *

Occupation *

Address *

City and State *

How long at this Address *

Daytime Phone *

Email Address *

How many adults are there in your family (their relationship to you)? *

How many Children (ages)? *

What type of home do you live in? Single family, town home, apartment, farm etc? *

Please describe your household *

Active

Noisy

Quiet

Average

If you rent, please give the rules governing pets and the landlords name and number. (by providing this information, you are allowing NARC to contact your landlord. Please inform them of this call so they will speak to us. *

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

Do you have time to provide adequate love and attention? *

What other pets do you have (specific type and number)? *

What type/brand of food do you or will you be feeding? *

Are your current pets up to date on Vaccines? *

Are these pets spayed/neutered? if not, why? *

Have you ever surrendered a pet? If so, why? *

Have you ever had a pet euthanized? if so, why? *

Have you ever lost a pet to an accident? *

How do you discipline your pets and why? *

Do you have a regular veterinarian? If no current vet, choose other and tell us who you will be using *

Yes

No

Other

Vets name and contact information *

What is your idea of an ideal dog and why? *

Desired age *

Desired Size *

Desired Breed *

What is the name of the dog you are interested in? *

Desired sex *

Male

Female

No Preference

Willing to adopt *

Where will the dog spend the day? (describe) *

Where will the dog spend the night? (describe) *

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 provide regular health care by a Licensed Vet? *

Yes

No

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

Yes

No

When to dog goes out, how do you supervise it? Fenced yard? *

Yes

No

Other

Do you agree to contact N.A.R.C. if you can no longer keep this dog? *

Yes

No

Are you willing to let a representative of NARC to visit your home by appointment? *

Yes

No

Would you be interested in fostering? *

Yes

No

Please list someone who is familiar with both you and your pets. Name, Address, Phone, Relationship. (relative, neighbor, friend, etc. *

Please list a Second Person who is familiar with both you and your pets. Must be Non-Related name, address, phone number, Relationship (neighbor, friend etc. *

Please list a Third Person who is familiar with both you and your pets. Must be Non-related: Name, address, phone number, relationship (neighbor, friend, etc.) *

Date: *

All of the information I have given is true and complete. This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Vet. In the event that the adopted dog does not work out, I will notify NARC and allow them to take the dog back into the possession of the Rescue.

Date *

Signature *

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