Adoption Application - Animal Refuge Kansai

Step 1 of 3

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About the applicant

Surname:(Required)

Given name(s):(Required)

Date of Birth(Required)

Sex(Required)

Male

Female

I prefer not to respond

Nationality:(Required)

Status of Residence (non-Japanese applicants):

Address:(Required)

Phone number (mobile):(Required)

Phone number (landline):

FAX number

Email address:(Required)

Email Address Confirm Email Address

Occupation:(Required)

How did you come to know about ARK?

Why do you want to adopt from ARK?

About the animal(s) you want to adopt

What kind of animals are you interested in adopting?(Required)

Cat(s)

Kitten(s)

Dog(s)

Puppy / Puppies

Other

If you answered "dog/s", what size dog are you looking for?(Required)

Small (Less than 10kg)

Medium（11-16kg）

Large ( more than 16kg ）

Your preferences: Eg. age, sex, personality, type, breed, etc.

Please tell us the name(s) of the ARK animal(s) you are interested in:

About your family:

Family structure(Required)

Please tell us your family members' names, ages and relationship to you.(Required)

Name

Age

Sex

Relationship

Is everyone in your household in favour of adopting an animal?(Required)

Yes

Who wants to adopt?(Required)

Who will be mainly responsible for the care of your new pet?(Required)

Home environment(Required)

Are pets permitted at your residence?(Required)

Yes

Unknown

Would it be possible for us to obtain a copy of the housing contract?

Yes

Would it be possible to obtain the landlord's agreement in writing?

Yes

Unknown

How long have you lived in your current home?(Required)

Are you likely to leave Japan?(Required)

Yes

Unknown

When are you likely to leave? Where are you likely to live?

What will happen with your pet if you leave Japan?(Required)

Do many children visit your home?

Yes

Do you have many regular visitors (people or animals)?

Yes

If yes, please tell us a bit about them.

Is anyone in your household expecting a baby?

Yes

Is anyone in your household allergic to animals?(Required)

Yes

Unknown

Who is allergic to which animals?

Regarding spaying/neutering of animals(Required)

I'm in favour

I'm opposed

Please tell us why you are opposed/concerned:

Your previous pets

Have you ever had a pet?(Required)

Yes

Have any of your pets run away?(Required)

Yes

If you answered yes, please tell us what happened.

Have you ever had to surrender a pet or leave one with friends/family?(Required)

Yes

If you answered yes, please tell us about it.

Please tell us about any relevant experience you have with animals.

Type of animal

Sex, neutered or not

How long did you have it?

Age it passed away

How it passed away

Any other relevant information.

About your other pets

Do you have any other pets?(Required)

yes

Please tell us about your other pets

Type(s) of animal(s)

Sex, neutered or not

Age

Personality, state of health

About your home and other pets

How many days a week will your pet be at home alone?(Required)

How long will your pet be left alone each day?(Required)

Please note any other relevant information about your absences

Where will your pet stay while you are away?(Required)

It will come with me.

Friends/family will petsit in their home.

Friends/family will petsit in my home.

I will employ a petsitter.

My pet will stay in a pet hotel.

長期不在はない

Other

Please tell us what you will do during extended absences

Where will you keep your pet during the day?(Required)

Where will you keep your pet during the night?(Required)

Where will your pet spend its time when you are out?(Required)

Please add any other relevant information

What will you do with your pet in an emergency?

Do you have a vet?

Yes

If yes, please tell us your vet's name, address and phone number.

May ARK staff visit your home?(Required)

Yes

Is your home surrounded by a fence / wall ofsome sort?

Yes

Is the wall completely sealed around your home?

Yes

Type of wall

Can we answer any questions or address any concerns?

I am applying to adopt from ARK having read and understood all the information contained in the "adopt" section of the website;(Required)

Yes

Privacy Agreement(Required)

I agree

I do not agree

I understand that all personal information I provide will be used only for the purpose of my adoption of a suitable animal and will not be provided to any third parties.