***THE NOAH PROGRAM ADOPTION APPLICATION*** (please print clearly)

Name__________________________________
Home Ph#_____________________
Work Ph #____________________
Cell Phone#__________________
Address __________________________________
City________________ State_____ Zip___________

1. In what type of housing do you reside?_____ Apt/Condo ____ Townhouse _____One

Family
Is there an HOA ?___ Y / N name/phone # _______________________________
Name of complex?
_________________________________________________
2. Do you ___own or ___rent?
If rent, does landlord permit pets? ___ Yes ___No ____ Not Sure
If rent, please provide landlord's name and phone
number._________________________________
3. Do you have a fenced yard? ____Yes ____No
Height of fence_____Ft. (Not Mandatory to have)
4. Household makeup: # of Adults ____ # of Children ____ Ages of Children
_______________
5. Does anyone in the household have allergies? ____Yes ____No
6. Which family member will have the major responsibility of caring for the pet?
_____________________________________________________________________________
7. How many hours a day will the pet be left alone? ______________________________
8. How close is your nearest neighbor? ________________________________________
9. Do any of your neighbors’ pets come into your yard? ____Yes ___ No
10. a]Will this be your first pet? ____Yes _____No
b]What type of pets did you previously own? ____Dogs ____Cats ____ Other
c]What happened to them? ___________________________________________________
d]What pets do you currently own?
Dogs/Breeds____________________________ ______
Cats _________________________
Other_____________________
e] If you currently own an animal(s), is it spayed/neutered? ____Yes ____No
____ Male ___ Female
f] If you currently own a cat(s), is it an _____indoor or an _____ indoor/outdoor
cat?
11. Who is your current veterinarian?
Name: ___________________________________________Phone # __________________
What last name & pet name are the veterinarian records under?
_______________________
12. Why do you want to adopt a Noah? __________________________________________
13. What gender do you prefer? ____Male ____Female
14. Where will your Noah spend the majority of its time?
____________________________
15. Do you agree to return your Noah to us if you are unable to keep it? _____Yes
_____No
16. Are you willing to provide us with follow-up reports? ____Yes ____No
17. When will you be ready to adopt a Noah? _______________________________
18. Do you use chemicals on your lawn (i.e., Lawn Doctor, Chemlawn)? ____Yes
____No
19. How did you hear about the Noah Program ? __________________________________

20. Which Noah are you interested in?

______________________________________________
21. Are you looking for an indoor cat/dog ___________ or an outdoor cat/dog
_______________
22. You understand that some of our Noah’s are “Special Needs” animals _____ Yes
_____ No

SIGNATURE__________________________________________DATE____________________

PLEASE RETURN TO: The Noah Program

1011 6th Avenue N. Ext.
Surfside Beach, SC 29575
Phone (843) 238-1414
Fax (843) 238-0476
E-Mail TheNoahProgram@Gmail.com
All applications will be reviewed and a decision will be made based on the
information provided.