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Adoption Application

First and Last Name:*
First Last
Email Address:*
Street Address*
Street Address Address Line 2 City State ZIP Code
Daytime Telephone:*
Evening Telephone:
Employer:*
Type of dwelling (Apartment, single family residence, duplex, townhome, condo, loft, etc?)*
Do you:*
- Own
- Rent
- Live at Home
If you rent: Are pets allowed?*
- Yes
- No
Landlords Name:
Landlords Phone:
Does your landlord require a security deposit?
- Yes
- No
(proof of payment required before the adoption can be completed)
Length of time at current residence?*
If less than one year at current residence, please provide previous address:*
Length of time at previous residence?
Do both adults work outside the home?
- Yes
- No
Number of adults in the home:
Number of children in the home and ages:
Do you currently have other dogs or cats?*
- Yes
- No
If yes, please give names, breeds and ages, as well as any other relevant information about the pet: (Type N/A if not applicable.)
If you have current pets, are they spayed/neutered?
- Yes
- No
If no, please explain as it is a requirement for approved adoption applications: (Type N/A if not applicable.)
If you don’t currently own a pet, have you owned one in the past?*
- Ye
- No
If yes, please explain why the pet is no longer with you: (Type N/A if not applicable.)*
Name/address/phone # for current veterinarian (To check current pet records.) or veterinarian that you plan to use (if you don’t have a current pet.)
Where will your pet stay during the day?*
Where will your pet stay at night?*
If you are adopting a cat/kitten are you planning to have it declawed?
- Yes
- No
If you are adopting a cat/kitten are you planning to let it go outside?
- Yes
- No
Why do you wish to adopt this type of animal?*
If you selected other above, please specify:
I certify that the information given on this application is true and correct. If I am approved to adopt an animal, I agree to all the above requirements. I understand that failure to comply with any of the requirements will result in confiscation of adopted animal.*
- I agree
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Comments
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Please Email us Directly at rememberingruthierescue@yahoo.com if you have not received a response within 24 hours.

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