Bringing People & Pets Together for the Benefit of Both

Important Note: All fields with a red * must be filled in order to send this form!

PERSONAL REFERENCE 1 location and contact info:

PERSONAL REFERENCE 2:

PERSONAL REFERENCE 2 location and contact info:

Have you previously adopted from or made a donation to Richland Animal Rescue?

Have you applied for a pet and been denied by another shelter or rescue? If yes, please tell us why the adoption fell through or you were turned away: Note: We do work with applicants other rescues may have turned away for various reasons; such as not having a fenced yard, apartment dwellers, partner orientation, age, family origin of ethnicity, etc.

BY SUMMITTING THIS APPLICATION, YOU CERTIFY THAT ALL INFORMATION GIVEN IS COMPLETE, TRUE, AND ACCURATE TO THE BEST OF YOUR ABILITY. YOU AUTHORIZE AND RELEASE FROM ALL LIABILITY WITHOUT RESERVATION, RICHLAND ANIMAL RESCUE, AND ANY PERSON GATHERING OR FURNISHING INFORMATION REGARDING THIS ADOPTION APPLICATION. Do you certify this application? *

Do you still have each pet?

NAME OF CURRENT VET and years of service?

CURRENT VET city and state:

CURRENT VET phone: *

Previous vet clinic AND years of service?

Previous vet phone:

If applying for a dog, are you familiar with heart worm disease and how it is transmitted?

Do you prefer a spayed/neutered pet, or an unaltered pet that can potentially be used for breeding?

If applying for a cat, do you prefer a cat declawed just in front, all four declawed, or not declawed?

If applying for a cat or dog, do you prefer an indoor or outdoor pet?

If your pet will be kept primarily outside, what type of shelter do you have set up for the pet?

Do you consider yourself a very responsible person and are you willing an prepared to take on all the responsibilities - including inherent risks - of owning a pet?

PERSONAL REFERENCE 1:

DO YOU HAVE A FENCED YARD?

DO YOU CURRENTLY HAVE PETS or have you owned pets in the last five years?

PLEASE LIST the names AND ages of ALL people residing at your home: *

If your pet is ever exposed to children - of any age - will you take extra care to observe and supervise, at great length, to make sure the pet is compatible with each child and each child is respectful of the pet?

How many hours per week does partner/spouse work per week?

Do you rent or own your home?

On average, how many hours per day will your pet be left alone?

Employer:

Employer Address:

Employer Phone:

How many hours do you work on average per week?

Partner/Spouse Employer:

Partner/Spouse Occupation:

Occupation:

HOME PHONE:

MOBILE PHONE:

Partner/Spouse Mobile Phone:

EMAIL:

COUNTY

WHICH PET ARE YOU APPLYING FOR?

APPLICANTS NAME: *

Additional comments:

Spouse/Partner Name:

HOME ADDRESS:

Short App - please use this contact form ONLY if you have been instructed to use the short application

FOR ADOPTIONS -- PLEASE FILL OUT AND SUBMIT THE ON-LINE APPLICATION BELOW

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Important Note: All fields with a red * must be filled in order to send this form!