Pet Adoption Application Form

Adoption Application & Questionnaire

Perspective Pet Parent*

First NameLast Name

Name of Pet You Wish to Adopt*

Email Address*

Phone Number*

Area CodePhone Number

Do you text?

Physical Address (where the animal will be living)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeUnited States

Do you have social media page and if so please list the account.

Would you be willing to be friends on facebook with the foster parent of the animal you are wanting to adopt?

Do you currently own any pets?*

Where did you learn of this animal being for adoption?*

Pet Name(s)

Pet Breed(s) & Ages

Pet's disposition and behavior towards other dogs?

Please provide your veterinarian's name and phone number:

Do you own or rent your home?*

OwnRent

Do you have a yard?*

YesNo

If "Yes" to the above, is it completed fenced? please describe.*

Would you allow for a fence check before the adoption is completed.

If you rent, what is your landlord's pet policy?

If you rent, please provide your landlord's information here:

Have you ever surrendered a pet you own to any animal shelter including a "low/"no kill" shelter or rescue?*

YesNo

Are there children in the home? (If yes, please list ages), senior or disabled persons.*

If you answered "Yes" to the above question, please provide detail:*

How many hours per day would the pet be alone?*

Will you crate your pet?*

If you have to leave town, emergently or planned, where would your pet stay?*

FYI: animals previously adopted from RRR&L received discounted boarding rates.

How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?*

Please provide the names, emails, and contact numbers for 2 personal references:*

Have you or anyone in your home been convicted of a felony?

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?*

YesNo

If you answered "Yes" please provide a detailed description:*

By clicking the submit button, I agree to Rustic Rover Rescue Inc. adoption process, will undergo a homecheck, and interview at the discretion of Rustic Rover Rescue Inc.
By clicking the submit button, I understand Rustic Rover Rescue Inc. will check my references including veterinary and personal.
By clicking the submit button, I understand there is an adoption donation associated with adoption of a pet from Rustic Rover Rescue Inc. and that it is not tax deductible according to IRS guidelines. I understand this donation/ adoption fee will ensure the organization is equipped to rescue another homeless pet.
By clicking the submit button, I understand that if I no longer want or can no longer care for my adopted pet, I agree to Rustic Rover Rescue Inc. BY EMAIL and provide a 14 day period to allow Rustic Rover Rescue Inc. to make arrangents for my pet to be taken back into rescue.
By clicking the submit button, I agree to indemnify and hold harmless Rustic Rover Rescue Inc. against any losses, lawsuits, claims, injury, damages incurred by me or to any persons or property by my adopted pet, once adoption has been completed.
By clicking the submit button, I understand that Rustic Rover Dogs Rescue Inc. will disclose any of the pet's health or behavior issues known by the above named rescue group before adoption is completed.
By clicking the submit button, I understand that if I no longer want my pet, or am no longer able to care for my adopted pet, I will be directed to surrender my pet to Rustic Rover Rescue Inc. and provide transport to where Rustic Rover Rescue Inc. deems appropriate.
By clicking the submit button, I verify all of the above information is true and accurate.

Signature of Potential Pet Parent*