Adoption Form | Northwest Animal Shelter

Adoption Application

First Name*

Last Name*

Email*

Street Address*

City*

Home Telephone*

Work Telephone

Other adult(s) at residence?

Yes
No

Are you interested in a particular cat or dog at the NWAS? Animals Name

If not, please note your preferences (age, gender, coat type, purebred/mixed breed, size, temperament, colour, etc).

Are you 18 years of page or older? (proof may be requested)*

Yes
No

Why are you considering adopting a dog or cat?*

Companionship
Breeding
Protection

Where would the animal be primarily housed?*

Inside
Outside
Both inside and outside

Where would the animal stay when you were not home?

Loose inside
Crated or otherwise confined inside
Loose outside
Kennel run/fenced outside
Tied/chained outside
Other (describe below)

Other

Animals can be expensive to care for (for example the estimated average annual cost is $750 for one dog).

I am willing and able to provide adequate food, shelter, medical care, plus yearly checkups and vaccinations.

Number of children living in the home?*

Ages of the children?

Do other children visit?*

Yes
No

If yes, what are their ages?

How often do they visit?

Does anyone in your household have allergies to animals?*

Yes
No

If yes, to what kind of animals?

Does your entire household know you are considering adopting a pet

Yes
No

If no, why not?

Household setting:*

Town
Country

Describe household:*

Do you own your own home?*

Yes
No

If you rent, you MUST provide proof of permission to have an animal on the premises. By giving us this information you are granting permission to have us contact them.

If renting, provide landlord's name and telephone number.

DOGS ONLY: Pleas describe your yard:

Fenced
Kennel run
Not fenced
Other

If fenced or kennel run, describe material used, height, and approximate size of fenced-in area as well as number of gates.

Describe what shelter would be available outside for the animal at your home

Other Shelter Description

Describe other animal problems

To help resolve any problems, are you willing to

Use a crate
Take an obedience class
Consult with vet

Under what other possible circumstances would you return the animal?

Move
New Baby
Divorce
Financial Difficulties

Describe other problems that would make you return an animal:

Describe your home’s activity level:*

Busy active/noise
Moderate comings/goings
Quiet/occasional guests

Do you feel that a pet should be spayed/neutered?*

Yes
No

If no, why not?

Please list all animals that you own (other than fish, birds, rodents, reptiles) including; animal, breed, time owned, ages, genders, spayed/neutered.

Who is responsible for the care of the above daily?

Who is responsible for the care of the above when you are on vacation

Name and telephone # of current veterinarian, if any:

By giving us this information you are granting permission to have us contact them.

Please list animals you previously owned (other than fish birds, rodents, or reptiles) and describe what happened to them::

Individuals who adopt a NWAS animal are contacted periodically for an update to help ensure that the animal successfully adjusts to its new life.

Do you consent to home visits before and/or after the adoption

What is the best time to call you at home to check on how the adopted animal is adjusting

If at any time an adopter cannot keep the animal, it must be returned to the NWAS. If the animal is not spayed or neutered at adoption, the adopter is required to alter the animal and provide a veterinary certification on request. Animals unaltered may be seized. In addition, each pet adoption is assessed a non-refundable fee to assist in paying the veterinary/other expenses incurred in the animal’s care.

By Clicking this I agree with the below statement.*

I acknowledge that I completely read this questionnaire, comprehend it fully, know that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application or the adoption contract can result in the forfeiture of any NWAS animal adopted by me.

Additional Comments

Would you like us to send you information about NWAS membership?

Yes
No

Please put me on your email list for news and fundraising events.

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