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					                      Yakima Valley Pet Rescue & Adoption Center
                      P.O. Box 944 * Yakima, WA 98907
                      509-248-3113 (message line)

                        DOG / CAT ADOPTION APPLICATION
                               (Applicants must be over 18 years of age)

                 *Completion of the application does not guarantee adoption*

Below is our adoption application. Please fill out the information and send it back via email ASAP. When
filling out the information please be descriptive and clear in answering all of the questions. (Please
underline, bold or italicize your responses.) We are searching for the best match for both the
prospective pet parent(s) and especially our fosters. Our adoption team looks forward to reviewing your
completed application.

Kind Regards,
Yakima Valley Pet Rescue & Adoption Center

*****Pet ownership is a serious responsibility. Our rescue wants to make sure that each person who adopts a
pet is aware of the responsibility and commitment which that pet requires. This application is designed to help
make the best placement possible. Getting the right home for one of our pets as well as the pet right for your
home is extremely important to us. Our adoption process varies in time length because we want to place the
right pet with you and give you all the information and support you need to have a successful adoption. Each pet
here at YVPR also looks forward to a life-long home.

To make certain that this adoption is in the best interest of both our prospective pet parents and our pets, we
ask that you complete the information and questions below. Please be explicit with your responses. This
information will help us place our cats/dogs in the best possible home, and at the same time find the best
possible pet for you.*****

Please read Terms of Adoption at the end of this application. If you do not agree with our pre-adoption
procedures, guidelines, or policies, we wish you good luck in your continued search.

To complete this application all you need to do is type in your answers directly into this word document (replace
line with information, save it on your computer, and then send it to us in an attachment (send it to:
yvpr2149@aol.com). Or you can copy and paste it into the body of the email. Please utilize e-mail, as hand
delivered or snail-mail responses are less likely to get reviewed in a timely manner. Good luck!

Please complete all information below.

Name: ____________________________________________________________ Date: _________________
Contact Numbers: Hm: ___________________ Wk: ____________________ Cell #: ____________________
Email Address: ____________________________________________
Residence Address: ____________________________________________________
City: ____________________________ State:_____________ Zip: _____________________

How long have you lived at your current address? ________________

Do you rent or own your current residence? ____________________
Residence type: apt / condo / duplex / mobile home / house / other

     Landlord's Name: _______________________ Phone: _________________

Do you plan on moving soon? ____________________ If so, when?_____________

For whom are you adopting this pet? ___________________            (i.e. self, family, children, friend)

Who will be the primary care taker of this pet? _______________

Why do you wish to adopt a pet? (Underline or highlight all that apply)

     Pet/Friend Hunter Guard/Protection/Watchdog Companion for other pet

What type of activities will your pet be involved in?

What type of pet do you wish to adopt? (Underline or highlight all that apply)

                                    Calm or active?            Male or Female?

Which pet(s) as listed online currently, were of particular interest?


What type of personality traits would you like your pet to have? ______________________________

List the pets you currently own below.

Please list whether the pet is a dog /cat/other, gender of pet, breed(s), whether they are spayed/neutered, age
of pet, kept inside or out.






Are they up to date on their vaccinations? _______ Have they been spayed / neutered?________

Veterinarian's name? __________________ Phone:__________________

Number of adults in household: _________________

Number of Children: _________

Ages of children: ________________________________________________
Do you plan on having children in the near future? If so, approximately when? Please EXPLAIN.


Please list all the past pet(s) you have had in the last ten years and why you no longer have them (i.e., died of
old age, euthanized, gave away, hit by car, etc.)







Do you have a fenced yard? __________ What type of fence? _________________ How high?____________

Where will this pet spend the majority of its time? (Underline or highlight which apply)

                           INDOOR               OUTDOORS              or          BOTH

Please EXPLAIN:__________________________________________________________________________

Where will this pet be when you are home?
Where will this pet be when you are at work? Explain. (Inside/outside & where?)
How many hours are you away from home each day? ________
How many hours maximum will the pet be left alone during the day?
Where will the pet sleep? Explain. (Inside/outside & where)

Who cares for your pet when you go on vacation? _______________________________

If you move, what will happen to your pet(s)?


Have you ever given up a pet or had one euthanized? _______________
Under what circumstances would you give up your pet?
If interested in a dog/puppy, do plan on going to formal dog training classes?
If interested in a dog/puppy, how do you plan on exercising this dog and how often?

All of the information I have given above is true and complete. I am in full agreement with all of the (11) terms
and conditions listed on the following pages and promise to abide by these terms for the lifetime of the pet that I
adopt from Yakima Valley Pet Rescue and Adoption Center.

I understand that Yakima Valley Pet Rescue and Adoption Center is not responsible for the accuracy of
information received about temperament or habits of cats/dogs available for adoption. I understand completely
that it is my responsibility to evaluate the pet 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 pet into my

Applicant(s) Signature (you will be asked to sign if application is accepted, all adults in household must sign):

1) __________________________________________________

2) __________________________________________________

3) __________________________________________________


                      Yakima Valley Pet Rescue & Adoption Center
                      P.O. Box 944 * Yakima, WA 98907
                      509-248-3113 (message line)

                                     TERMS OF ADOPTION
The following agreement specifies what we feel is required to provide an appropriate home for a pet. The
conditions set forth are based on our experience and a continuing commitment to see that our rescue puppies
are well matched to a family/owner.

If I am successful in the adoption of a pet through Yakima Valley Pet Rescue and Adoption Center, I herein
promise and agree to the following conditions:

    1. To keep this pet in my personal possession, provide proper and sufficient food, water, shelter,
        grooming, and humane treatment at all times.
    2. Not to sell, trade, transfer ownership, abandoned, or dispose of this pet in any way.
    3. In the case of a dog, they will be maintained as an indoor house dog and family companion. It will not be
        maintained outside as a yard dog or in a basement, garage, or outbuilding.
    4. I will not use the pet for medical or any other experimental purposes.
    5. If a dog, I will ensure that when outside and unattended, the dog is in a secure fenced yard. To never
        allow him or her to run loose without adult supervision. The dog will never be chained or tied outside, in
        a garage or basement.
    6. This pet will not be transported in the open bed of a pick up truck or similar vehicle without being
        enclosed in a properly secured crate.
    7. If a dog, I agree to enroll in, and attend at least one obedience course with this dog. Petsmart, Petco,
        and other pet store classes are NOT recommended. Please see attached sheet for recommended dog
        training schools.
    8. To procure any veterinary care at once if it becomes sick or injured and to keep current on all
        vaccinations against rabies, distemper, parvo, corona and kennel cough viruses. Follow through with
        continued flea/tick treatment.
    9. To provide him or her with a current ID tag secured to a collar which will be worn at all times. In addition,
        it is recommended that each pet be micro chipped, as a means of permanent identification.
    10. To obey all Animal Control regulations governing the area in which I live, and to license this pet
        according to such regulation.
    11. I agree to have this pet spayed/ neutered at my expense following the requirements of having a pre paid
        receipt from my veterinarian. I will not allow this pet to breed or be bred under any circumstances.
    12. YAKIMA VALLEY PET RESCUE & ADOPTION CENTER reserves the right to an ongoing review of this
        adoption and to follow-up on any complaints or reports, including an examination of the pet and its living
        conditions, to protect welfare of the pet throughout its life. If the terms of this agreement are not
        satisfactorily upheld by the adopter(s), and/or any misrepresentations have been made in order to
        obtain this cat/dog, Yakima Valley Pet Rescue and Adoption Center reserves the right to terminate this
        agreement and demand the surrender of the said pet immediately.

Yakima Valley Pet Rescue and Adoption Center

Catherine Leonard, Adoption Coordinator: YVPR2149@aol.com

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