Adoption application｜Adopt｜Animal Refuge Kansai

Thank you for considering adopting an animal from ARK.
Please make sure you understand our adoption process.
The questions on this page are designed to help us to match a suitable dog or cat to you and your family.
We suggest you read right through this questionnaire before starting to fill it out!
[Fields marked * are mandatory.]

DISCLAIMER: To protect the welfare of the animals in its care, ARK requires any person applying to adopt an animal from ARK to complete an application providing personal information. The application shall be retained by ARK, and the information contained therein shall be treated as confidential.

ARK is under no obligation to accept an application for adoption. ARK retains the right to refuse or reject any application. Any decision by ARK to refuse or reject an application shall be final and without recourse by the applicant. ARK shall not discuss the reasons or provide justification for the refusal or rejection of an application.

Section 1 : About you…

* What is your name?

* What is your date of birth?

* What is your nationality?

What is your visa status in Japan (if applicable) ?

* Your main e-mail address?

* Please type that same email address again

Your mobile phone email address?

* What is your full home address? If the animal will be kept at a different address, please write that too.

Main mobile phone number

Secondary mobile phone number (add explanation if appropriate…)

Other mobile phone number (add explanation if appropriate…)

Daytime phone number

Evening phone number

Fax number

* What is your occupation or employment?

* Are you or your partner/spouse/family likely to be transferred overseas?
Yes No
… if yes, when is this next likely to happen – and which country are you likely to be transferred to?

* Who is the animal you want to adopt for?
Myself A child My whole family Other
… if other, please specify

* Would you be the main person responsible for the welfare of the animal you wish to adopt?
Yes No
… if not, who would be?

* Are you opposed to the neutering of animals?
Yes No
… if so, why?

Section 2 : About your family…

* Does everyone in your household agree with the decision to adopt an animal?
Yes No
Please list all the adults (over 18) in your home, their ages and their relationship to you. (E.g. John Smith, 45, husband.)

Please list the names of children 7 years or over in your home, with their ages.

Please list the names of children under 7 years in your home, with their ages.

* Do you often have a lot of other children coming to your home?
Yes No
… if so, how many and what are their ages…

* Apart from family members, do you often have visitors coming to your home?
Yes No
… if so, what kind of people/animals?

* Does anyone in your family plan to have a baby in the near future?
Yes No
* Are you or any of your family members allergic to dogs and/or cats? (Specifically, allergic to the kind of animal you want to adopt.)
Yes No
* Do you have a veterinarian?
Yes No
… if yes, please tell us his/her name, address and telephone number.

Section 3 : About the animal you want to adopt…

* Please select the type of animal(s) you wish to adopt
Kitten Cat Puppy Dog Other
Which animal, specifically, are you seeking to adopt? (Please enter the Ark Number and/or the animal’s name.)

* In addition to any animal you may have specified above, please tell us what sort of animal you are looking for. If you are looking for a dog, specify whether small (less than 10kg), medium (10-15kg) or large (more than 15kg).

* Why do you wish to adopt an animal from ARK?

Section 4 : What you can offer an animal…

* Please tell us any relevant experience you, or any members of your family have with regard to looking after animals

* For how many hours would the animal be alone on your regular or working day?

… roughly, from what time? (indicate am/pm)

… to what time? (indicate am/pm)

* Where do you plan to keep the animal?
Indoors Indoors and outdoors Outdoors
* What kind of environment would the animal be kept in?

* Where would the animal live during the day?

* Where would the animal live in the evening?

* Where would the animal live while you are not home?

* How much time do you spend travelling or on vacation in an average year?

* Who will look after your pet when you are away, on holiday, etc?

* What would happen to your pet if/when you decided to leave Japan?

* Would you allow a member of the ARK staff to visit your home to check on the welfare of your adopted animal?
Yes No

Section 5 : About your current pets (if any) …

* Do you currently have any pets? (If you answer “no”, please move on to the next section.)
Yes No
If you have dogs, please list their breeds, sexes (M/F) and ages.

If you have cats, please list their breeds (‘Japan Cat’ if not known), sexes (M/F) and ages.

If you have other types of pets, please list their types, sexes (M/F) and ages.

Have all your dogs/cats been neutered/spayed?
Yes No
Have all your dogs/cats been vaccinated and are their vaccinations up to date?
Yes No
Are all your dogs and cats in good health?
Yes No
If you answered “No” to any of the last 3 questions, please give full details.

Do any of your dogs have a problem with aggressive behaviour?
Yes No
If yes, please give details:

Did you purchase any of your current pets from a breeder, a pet-shop or similar?
Yes No
… if so, which ones

Section 6 : About previous pets (if any) …

* Have you kept pets before? (If you answer “no”, please move on to the next section.)
Yes No
…if yes, please tell us a little about them (type, etc) and how they parted from you. There are no “right” or “wrong” answers in this section, so please don’t be afraid to answer honestly and give the background.

Have you ever had a pet run away?
Yes No
… if so, please tell us how it happened.

Have you ever given an animal away?
Yes No
… if so, please tell us the background.

Have you had an animal put to sleep / euthanised?
Yes No
… if so, please tell us the reason. (e.g old age, illness, behavioural problems, or specify other reasons.)

Have you ever had an animal die in an accident?
Yes No
… if so, please tell us what happened.

Has one of your animals ever died due to illness?
Yes No
… if so, please tell us the symptoms and cause of death.

Section 7 : About where you live

* Do you live in a:
Rented House Rented Mansion/Apartment Own House Own Mansion/Apartment Other
… if “Other” please explain …

If you rent a house/mansion/apartment, OR own a mansion or apartment and are subject to a building agreement, does the contract or agreement specifically allow pets of the type you wish to adopt?
Yes No
Would it be possible for us to obtain a copy of the housing contract/agreement, or your landlord’s agreement to your keeping pets in writing?
Yes No
* How long have you lived at your current address?

* How long did you live at your previous address?

* Do you plan to move in the next six months?
Yes No
* If/when you move, what will happen to your pet?

Please specify if there are any limitations to weight/size/number of animals you may keep in your building.

If you would like to expand on or clarify any of your answers in this section, please do so here.

Section 8 : If you are looking to adopt a dog…

Is your home surrounded by a fence or wall?
Yes No
Does the fence/wall completely seal the garden and is it dog-proof? (We will ask you to provide photographs and /or bring a drawing of the site when you visit ARK.)
Yes No
Type of wall/fence
Net fence Block Metal pole and block Metal pole Wood Other
… if “other”, please specify fence type

If the dog will live in a kennel, what is the kennel made of?
Wood Steel Plastic Other
…if “other”, please specify kennel type

Where would you walk/exercise your dog?

Would you be willing to allow ARK staff to visit your home prior to any adoption?
Yes No

Section 9 : Other Information…

How did you hear about ARK? (Select all that apply)
Word of mouth News/mag Internet
Other means by which you heard about ARK, if any

Please add any additional information or clarifications you would like us to consider.

Section 10 : Agreement

* All ARK animals are vaccinated, neutered and micro-chipped prior to adoption. If you adopt an animal from ARK

We ask that you:

1.Register immediately with a veterinarian (if you do not already have one).
2.In principle, keep cats indoors at all times.
3.Fit a collar, with a name-tag containing contact details, to all cats and dogs, without exception, even those dogs that live exclusively indoors.
4.Walk dogs using a harness rather than a lead attached to the collar. Leads fitted to collars are bad for a dog’s neck. We also ask that you don’t let a dog run free until you are quite sure you have control of it.

In addition, we will ask you to sign an “Adoption Pledge”. It says…

I pledge that:

1.I will care for this dog / cat in a responsible manner befitting a companion animal;
2.I will contact ARK immediately if the animal should go missing;
3.If I become unable to care for this animal, I will not give it to another person without permission from ARK;
4.I will provide appropriate treatment for this animal in the event of illness or accident and will not allow it to suffer. When treatment is not possible or suffering is imminent, I will have the animal euthanized by a competent veterinarian

I acknowledge that:

1.ARK retains the right to call on the animal at any time without notice;
2.This animal is in good health unless otherwise stated. ARK will not be held responsible for any illness or fees incurred in the treatment of illness from the date shown below.
3.Dogs must receive rabies vaccinations every year in accordance with the Prevention of Rabies Ordinance and agree to register all dogs in my care with the local civic office. I further agree to attach registration and name tags;
4.Dogs and cats must be given annual vaccination boosters, as advised by my veterinarian;
5.ARK retains the right to take an animal back into its care should its standards and conditions not be met. Adoption fees will not be refunded under these circumstances.

I agree. I disagree

Send this application to:

Select the ARK office the animal you are interested in is registered with. If you are not sure, select Tokyo.
ARK Osaka ARK Tokyo

Adoption application

If you do not get a response…

Adoption application form.