Adoption Application
The Humane Society of Central Washington is a non-profit organization committed to the welfare of all the animals in our care and considers pet ownership a serious responsibility. We want to ensure that each person who adopts a pet is aware of the responsibility and commitment that a pet needs. This application will aid us in determining if the adoption is in the animal's best interest, and to assist you in finding the pet that is most compatible with your lifestyle. The adoption process takes some time because we want you to have all the necessary information and support your need for a successful adoption. We ask for your cooperation throughout the process of uniting people and pets. Thank you for your honesty and patience. All adopters must be at least 18 years old to adopt. If you rent please be prepared to submit a written statement (i.e. Rental Agreement, note, etc..) from your landlord stating that you can have pets in your home.
First Name Last Name
Spouse/Partner's Full Name
Street Address City State Zip Code
Home Phone Work Phone Cell Phone
Email Address
Emergency Contact Phone
Date of Birth Age Occupation/Employer
Rent or Own your home? Type of Residence
If you rent please provide your landlords contact information
If you rent, please email (adoptions@yakimahumane.org) or fax (509-457-6919) your landlord approval (i.e. rental agreement, statement from landlord, etc..) at your earliest convenience.
Have you ever adopted a pet from our facility? If yes, when?
What happened to the pet you adopted from our facility? (if applicable)
Have you ever adopted a pet from another shelter or rescue group? If yes, when?
What happened to the pet you adopted from the other shelter/rescue group?
Why would you like to adopt a pet from our facility today?
Who are you adopting this pet for?
Who will primarily be responsible for the care of this pet?
Number of adults in the household? Is everyone in agreement regarding this adoption?
Please list the ages of children that will frequently come in contact with this pet
What will you do with this pet if you move to another home?
Are you prepared to accept the cost of an animal in your home including Veterinary care?
Who is your Veterinarian? Veterinarians Phone
How will you transport this pet home, to the Veterinarian, etc...?
Where will this pet be kept during the day? At night?
How will you keep this pet confined to your property?
Please list all pets currently living in your household (species, breed, sex, age, spayed/neutered, and indoor/outdoor).
Please list all pets previously owned (species, breed, spayed/neutered, how long owned, and what happened to that pet).
The animals available for adoption came to us from a variety of sources, and their health is routinely monitored while at the shelter, but there is always a chance that an animal is harboring a disease without showing any clinical signs. After the 14-day health guarantee any adopted animals become the sole responsibility of the adopter.
The Humane Society of Central Washington reserves the right to refuse adoption to anyone. No animal will be adopted to persons having an extensive history of losing, giving away, selling, or breeding animals. No animal will be adopted to prospective owners who mislead or fail to provide accurate information on the adoption application. The Humane Society reserves the right to do home inspections to verify that suitable living conditions are being provided for any pet adopted from us.
I certify that all the information contained in this application is true and correct to the best of my knowledge. I understand that providing false or misleading information on this application is grounds for denial of my application. I further understand that this application, once submitted, becomes the sole property of the Humane Society of Central Washington.
I understand that by typing my full name in the box below I am digitally signing this application for adoption.
INCOMPLETE APPLICATIONS WILL BE DISCARDED
Signature Date
ID # of the animal you are interested in adopting