Yelm Animal Alliance Adoption Application

Yelm Animal Alliance PO Box 639 Yelm, WA 98597

Date: Name of dog desired: Color(s):
Age of desired dog: Oldest age considered: Adult desired wt:
Applicant Information
Name:
Mailing address:
Physical address (if different):
City: Zip:
Telephone numbers: Home Work Cell
E-mail address: Age:
Number of people in household: If children are present, ages:
Are any members of your family allergic to pets? If so, what animals?
Are you presently: Employed Employer: Unemployed Retired Student
Co-Applicant Information
Name: Relationship to above:
Telephone numbers: Home Work Cell
E-mail address: Age:
Are you presently: Employed Employer: Unemployed Retired Student

General Information

Type of residence: House Apartment Condo Mobile home Farm/Barn
If rental, are dogs allowed? Any size or breed restrictions: (please note)
Name of Manager/Landlord: Phone number:
Current housing location. In City: In County:
Type of street: Very busy Slight traffic Residential Country Road Speed limit:
Where will dog live? Inside only Outside only Mostly Inside Mostly outside
Where will the dog spend nights? Inside Outside
Do you have a fenced yard: If yes, how high?
Will you allow your dog to run loose? If yes, where?
How many hours a day will the dog be alone? Where will the dog stay when alone?
Describe activity level in your home: Busy (visits by friends, meetings, children, parties)
Noisy (TV, stereo, machinery, tools, children playing, dogs barking)
Moderate (Normal comings and goings)
Quiet (Homebodies, few guests)
Other (Specify)
Under what circumstances would you return the dog to us? Job Divorce Baby Move Illness
Other (Specify)
In absence of primary caregiver, who will care for dog:
Under what circumstances would you return the dog to us? Job Divorce Baby Move Illness
Are you willing to take responsibility if this dog acquires an illness or tests positive for heart worms?
Are you willing and able to pay the veterinary costs for your new dog? Yes No
Are you willing to work with this dog on housebreaking & chewing (if applicable)? Yes No
Would you consider obedience training for your dog? Yes No
How much time are you prepared to allow for your new dog to adjust to your home:

Other Pet Information

Have you had pets in the last 5 years? If yes, please fill out the form below.
Name/Breed of pet / Yrs. owned / Spayed/Neutered / Kept inside or outside? / Where is pet now?
Yes No / In Out Both
Yes No / In Out Both
Yes No / In Out Both
Yes No / In Out Both

Who is your past or current Veterinarian/Clinic: ______

Do you consider your dog a part of the family?
Are you aware that a dog is a large and lifelong commitment?
How did you hear about Yelm Animal Alliance?

Personal References

Name: ______Relationship: ______

Phone number: ______Best time to contact: ______

Comments:

Adoption Application 2/2010