Dog Adoption Application - Yakima Valley Pet Rescue and Adoption Center

Please fill out the form COMPLETELY. Incomplete applications will not be considered. Thank you!

Fields marked with an * are required

Date *

First Name *

Last Name *

Email *

Residence Address You may be asked to show proof of address. 

City

State

Zip

Home Phone (include area code)

Cell Phone (include area code)

Other Phone (Work) Include area code

What is the name of the dog you wish to adopt?

Please give brief description of the dog.

For whom are you adopting this dog?

Please select one:
Self
Family
Children
Friend
Other

Who will have primary responsibility for the care and supervision of dog?

Why do you wish to adopt a puppy/dog?

Companion
Hunting dog
Protection/watch dog
Companion for other pet
Other (please explain below)

If other, please explain.

What type of activities will your dog be involved in?

What type of dog do you wish to adopt?

No preference
Calm
Active

What gender dog do you wish to adopt?

No preference
Male
Female

What age dog do you wish to adopt?

No preference
Puppy
Adult
Older

What other types of personality traits would you like your dog to have?

How many years have you lived at your current address?

Please select one:
Less than 1 year
1 year
2 years
3 years
4 years
5 years or more

What is your current living arrangement? Please explain in detail. (Rent, own, other, etc.) *

If you rent, are you allowed to have a dog?

Not applicable
Yes
No
Unsure

Type of residence? *

Please select one:
Apartment
Condo
Duplex
Mobile home
House
Other

If you have a landlord, please give their name and phone number.

Do you plan on moving soon (in less than 1 year)?

Please select one:
Yes
No

What would happen to the dog should you move?

ListPeople

List all people living in your home, include all children.

Please provide your age *

Person 1: Name/Relationship/Age

Person 2: Name/Relationship/Age

Person 3: Name/Relationship/Age

Person 4: Name/Relationship/Age

Person 5: Name/Relationship/Age

List any additional people here: (Name/Relationship/Age)

If your child is five years or under, are they accustomed to being around puppies or older dogs? (please explain in detail)

Does anyone in the household have allergies to dogs?

Please select one:
Yes
No

If yes, please explain. (give details of allergies and how you plan to cope with new dog)

Are you willing and able to accept the cost of this dog's care and medical needs for the remainder of its life? (i.e., medical expenses, vaccines, food, accessories, etc.)?

Please select one:
Yes
No
Unsure

ListPets

List the pets you currently own below. (if you currently have no pets, leave blank) Please list whether each pet you own is a dog/cat/other, gender of pet, breed(s), whether they are spayed/neutered, age of pet, kept inside or out.

Pet 1

Pet 2

Pet 3

Pet 4

Pet 5

Are your current pets up to date on their vaccinations?

Please select one:
Yes
No
Unsure
Not applicable

Have they been spayed/neutered?

Please select one:
Yes
No
Some of them have
Not applicable

If you have a pet that is not yet neutered, please explain why.

If you have another dog(s), are they socialized and friendly with other animals?

Please select one:
Yes
No
I don't currently own a dog

What potential problems do you feel unprepared for? (i.e. biting, allergies, furniture scratching, etc.)

Do you already have a veterinarian for the dog you wish to adopt?

Please select one:
Yes
No

If so, please give name and contact number.

If not, who will be your veterinarian? Name and contact number.

Have you owned a pet in the last ten years?

Please select one:
Yes
No

ListPastPets

If yes, list all past pet(s) you have owned in the last ten years and why you no longer have them (i.e., died of old age, euthanized, hit by car, breed, age of pet, etc.) If you haven't owned a pet in the last ten years, leave blank.

Pet 1

Pet 2

Pet 3

Pet 4

Pet 5

Do you have a fully fenced yard?

Please select one:
Yes
No
No, but in process of fencing it

What type of fence?

How high is each side of the fence?

Where will this dog spend the majority of its time?

Please select one:
Indoors
Outdoors
Both

Please explain:

Where will this dog be when you are home?

Where will this dog be when you are at work?

Please select one:
Indoors
Outdoors
Both

Please explain:

How many hours are you away from home each day?

Please select one:
Less than 2
2 - 4
4 - 6
6 - 8
8 - 10
10 - 12
12 or more

How many hours maximum will the dog be left home without human contact during the day?

Where will the dog sleep? Please be specific.(inside, on bed, in crate, outside kennel, etc.) *

Who will care for your dog when you go on vacation?

Please select one:
Friend
Neighbor
Kennel
Will go with us

If dog will stay home (please explain)

Under what circumstances would you give up your puppy/dog?

Do you plan on taking your dog to formal dog training classes?

How do you plan on exercising this dog and how often?

Divider

How did you find us?

Please select one:
Petfinder
YVPR website
Facebook

Friend - who?

Another Rescue - which?

Other (please explain)

Divider Copy

Do you have a Facebook page?

Please select one:
Yes
No

I understand that a dog adopted from a rescue may take more time to form a bond, may display fearful behavior initially, and may take time to gain trust and adjust to its new surroundings and family? Do you understand that a dog adopted from a rescue may need more time and attention initially to help overcome trauma it may have endured in its past? *

Please select one:
Yes
No
Unsure

I understand that Yakima Valley Pet Rescue and Adoption Center is not responsible for the accuracy of information received about temperament or habits of puppies and dogs available for adoption. I understand completely that it is my responsibility to evaluate the dog for myself before agreeing to adopt it. Yakima Valley Pet Rescue is in no way liable or responsible for any damage, accident or injury resulting from the placement of a dog into my household. *

Please select one:
Yes
No

I understand that Yakima Valley Pet Rescue and Adoption Center reserves the right to refuse to adopt any dogs to applicants we feel would not be in the best interest of the animal. We also reserve the right to refuse any adoption, without justification, and not all applications or inquiries may receive a response. *

Please select one:
Yes
No

I understand that it is crucial for adoptees to pick up their dog (if your application has been approved) in a timely manner, as we need to free up our foster home space to take in more homeless pets. *

Please select one:
Yes
No

I understand that the Yakima Valley Pet Rescue and Adoption Center is composed entirely of volunteers and that although they do their best to respond to adoption applications in a timely manner, that they are human and are doing the best they can for the animals with the resources they have and I promise to be patient, understanding, and nice to them. *

Please select one:
Yes
No

Acknowledge

By clicking the Submit button below I acknowledge that all of the information I have given above is true and complete.

If the application does not submit, please scroll up to check for missing data.

If you are a human seeing this field, please leave it empty.

Please fill out the form COMPLETELY. Incomplete applications will not be considered. Thank you!

If the form does not submit, please scroll up and look for missing data.