RESCUE ANIMALS IN NEED INC. ADOPTION FORM

PLEASE COMPLETE THIS APPLICATION TRUTHFULLY AND IN ITS ENTIRETY. WE RESERVE THE RIGHT TO REFUSE ANY ADOPTION. A REFUSAL DOES NOT REFLECT ON YOU PERSONALLY, RATHER IT MEANS THE CIRCUMSTANCES ARE NOT SUITABLE FOR THIS PARTICULAR PET ADOPTION.

NAME OF ANIMAL APPLYING FOR

LAST NAME*

FIRST NAME*

M.I.

STREET ADDRESS*

APT NUMBER

CITY*

STATE*

ZIP CODE*

LENGTH OF TIME AT CURRENT ADDRESS*

PHONE NUMBER*

TYPE OF PHONE*

ALTERNATE PHONE

TYPE OF PHONE

EMAIL ADDRESS*

DRIVERS LICENSE #

DATE OF BIRTH*

ARE YOU OVER 21 YEARS OF AGE?*

PETS OWN IN THE LAST 5 YEARS : NAME OF PET, TYPE OF PET, DATES YOU HAVE HAD THIS PET (WHEN UNTIL WHEN), SPAYED/NEUTERED, UTD ON VACCINES*

PERSONAL REFERENCE: NAME, PHONE #, RELATIONSHIP*

VETERINARIAN: NAME, ADDRESS, PHONE # (please note that RAIN will be contacting your veterinarian for reference)*

HAVE YOU EVER BEEN CHARGED WITH AN ANIMAL RELATED CRIME OR OFFENSE?*

NAME OF EMPLOYER*

ADDRESS OF EMPLOYER*

PHONE # OF EMPLOYER*

REASON WHY YOU WANT TO ADOPT THIS PET*

NUMBER OF ADULTS IN THE HOME*

NUMBER OF CHILDREN IN THE HOME*

IS EVERYONE IN THE HOME AWARE THAT YOU ARE ADOPTING A PET AND AGREE TO TAKING CARE OF THE ANIMAL?*

DOES ANYONE IN THE HOME HAVE PET ALLERGIES?*

WHO WILL BE CARING FOR THIS PET?*

WHERE WILL THE PET BE KEPT?*

HOW MANY HOURS A DAY WILL YOU SPEND WITH THIS PET EACH DAY?*

REASONS YOU WOULD SURRENDER AN ANIMAL?*

HAVE YOU EVER HAD TO GIVE UP A PET?*

IF YES, WHY?*

DO YOU OWN YOUR HOME?*

LANDLORD PERMISSION

Upload a File

NAME OF YOUR COMMUNITY*

ARE THERE PET RESTRICTIONS IN YOUR COMMUNITY?*

IF YES, PLEASE DETAIL RESTRICTIONS*

HOW DID YOU HEAR ABOUT RAIN?*

I certify that my answers are true and complete to the best of my knowledge. I understand that providing false information may result in the immediate denial of my application.

I understand that RAIN may contact my references, veterinarian, and employer if necessary and I authorize the release of any information pertaining to this adoption.

I understand that RAIN may perform follow up emails, calls, and even home visits to see my adopted pet and it's living conditions at any time after the adoption and I understand that I will give RAIN full access to the pet upon request.

If this application leads to the approved adoption, I understand that false or misleading information in my application or interview may result in the termination of the agreement and immediate surrender of the pet.

TODAYS DATE*

MonthDayYearHourMinutesAM/PM Option

SIGNATURE OF ADOPTER*

RESCUE ANIMALS IN NEED INC. ADOPTION APPLICATION