Northwest International Pet Rescue
(NWIPR)
Adoption Application
The answers you provide on this application will help us determine the best possible match between you and the dogs available. Please complete the below form in detail and submit it to Northwest International Pet Rescue (NWIPR). Please notify us at f you are having any difficulties.
Top of Form
Applicant's Contact Information
Name: ______
Address: ______
City: ______State: ______Zip: ______
Home Phone: ______
Work Phone: ______
Cell Phone: ______
Best time to call: ______
Email: ______
Employment Information
Occupation: ______
Spouse Occupation: ______
How long at your present job: ______
Personal Reference - please list someone other than a family member
Name: ______
Relationship: ______
Years Known: ______
Home Phone: ______
Best time to call: ______
Home Environment Information
Type of dwelling you live in:
House______Apartment______Condo/Town House______
Trailer______Duplex ______Other ______
Do you own ______or rent______?
If renting, please indicate that you have your landlord's permission to keep a dog, and list any size/weight/breed restrictions:______
Landlord's contact information: ______
How long have you lived at this address: ______
Do you have fenced yard: Yes______No______
Type & Height of Fence: ______
Does fencing completely enclose a yard for a dog? Yes _____ No______
If no fence, how will you handle the dogs exercise and potty needs, etc.? ______
Number of adults in household:_____ Number of children: _____
Men:______Ages:_____Boys:_____Ages:______
Woman: _____Ages:_____ Girls:_____Ages:______
Are you expecting a child or planning a family in the near future? Yes____ No ____
Do you or does anyone in your family have allergies? ______
Are all family members in agreement about adopting a dog? Yes_____ No______
Do you own cats? Yes ____ No_____
How many? ______
Are they indoor____, outdoor_____ or both_____?
Are they spayed or neutered? Yes_____ No______
Other animals? ______
**Please include a copy of your lease
**If you live in a condominium/co-op, or your house is part of a homeowners association, please provide a copy of the bylaws, rules and regulations of such organization stating that there are no restrictions regarding owning a dog. If there is a limit on the number of pets you are allowed, please note the limit on the copy of the bylaws.
Pet Ownership Information
Do you have a regular veterinarian? Yes______No______
Name of Veterinarian for current and/or previously owned animals:
Address and Phone of Veterinarian: ______
(need all vets that have seen your pets for wellness exams and vaccinations in the last 7 years)
What name are your pets seen under, if not the name on this application? ______
Can Northwest International Pet Rescue (NWIPR) contact your veterinarian? Yes ______No______
How many dogs and cats have you owned in the last 15 years? ______
List All Pets You Presently Own:
Dogs:
Breeds:
Ages:
Male or Female:
Spayed or Neutered:
Indoor/Outdoors:
How Long Have you Owned:
Cats:
Breed:
Ages:
Male or Female:
Spayed or Neutered:
Indoor/Outdoors:
Is your cat(s) declawed? Yes____ No ____
How Long Have you Owned:
For all dogs & cats you have previously owned list name, age, sex, breed, spay/neuter status and what happened to the dogs & cats.
Dogs:
Breeds:
Ages:
Male or Female:
Spayed or Neutered:
Indoor/Outdoors:
How Long Have you Owned:
What happened:
Cats:
Breed:
Ages:
Male or Female:
Spayed or Neutered:
Indoor/Outdoors:
Is your cat(s) declawed? Yes____ No ____
How Long Have you Owned:
What happened:
Have you ever rehomed a pet? Yes _____ No_____ Explain:
Did you take your previous pets to obedience? Yes______No______
If you have a current dog, would you describe him as being alpha or submissive to other dogs? Answer & explain:
Which pet are you interested in adopting?
Describe your ideal dog:
Briefly describe your breed experience and why you chose this breed:
In your research of this breed, is there anything that might be an issue for you:
What activities do you plan on participating in with your dog(s): (All plans for the pet)
Where will the dog spend the day:
How many consecutive hours a day are you away from home for work, school, etc?
On average, how many hours, will the dog spend without human company each day?
Where will the dog spend the night:
Do you agree to license this dog and give him/her regular health care?
Do you agree to contact Northwest International Pet Rescue (NWIPR) if you can no longer keep this dog?
Would you be willing for someone to visit your home by appointment for a home check or submit photos of your home?
All of the above information I have given is true and complete. If I adopt a dog from Northwest International Pet Rescue (NWIPR), the pet will reside in my home as a pet. I will provide him/her with adequate water, a high quality dog food, shelter, training, affection and medical care. I understand that Northwest International Pet Rescue (NWIPR) is a referral service and is not responsible for the accuracy of information received about the habits, temperament, or physical condition of the dogs available for adoption. I understand it is my responsibility to evaluate a dog for myself before agreeing to adopt him/her. I am in full agreement of the terms of the adoption. Northwest International Pet Rescue (NWIPR) shall not be liable for, and is hereby relieved from, all liability for any damage, expenses, causes of action, fines, suits, demands, judgments, or claims of any nature whatsoever arising from or by any reason of any damage to property or injury to any persons caused in whole or in part during the visitation of the dog up for adoption AND a dog placed in your home. I hereby accept and assume such liability and agree to protect, indemnify and hold Northwest International Pet Rescue (NWIPR) harmless from and against all of the aforesaid.
Completing and returning this document constitutes your permission for us to check references.
Application Signature:
Date:
Both parties agree that this application can be executed by the applicant and sent to Northwest International Pet Rescue (NWIPR) via hand delivery, US Mail, Fax, Federal Express or any other recognized overnight delivery service or by Email. If the applicant would like to send the document via email, applicant and Northwest International Pet Rescue (NWIPR) both agree that the applicant’s signature is valid and binding upon the parties.
Thank you for contacting Northwest International Pet Rescue (NWIPR).
We look forward to working with you.
WE RESERVE THE RIGHT, IN OUR SOLE DISCRETION,
TO REFUSE ANY APPLICANT FOR ANY REASON WHATSOEVER.
All contents © copyright 2009 NWIPR. All Rights Reserved