First Name Middle Last Name
Date of Birth Married Single
Spouse or Significant Other
Phone (home) (work) (cell)
Children living in the home:
Name and age
Other people who live in the household:
Address (residence where the animal will be living:
Street City State Zip
Own Rent How long at this address?
If you rent, provide name, address and phone number of your landlord:
Name Phone
Address
What type of home do you live in? Single Family Dwelling Condo Apartment
Trailer Duplex Other
Please describe your housing accommodations for your pets:
Please describe your yard and fencing for your pets:
Other Animals and Pets In Your Home:
Type: Age: How long in your care
Where obtained:
Other
Veterinarian Information:
Clinic Name How long a client?
Your household's annual income range:
$10-20,000 $20-30,000 $30-40,000 $40-50,000 Over 50,000
Your employer: Phone
Street Address City State Zip
Real Rescue does require a home visit prior to final approval of the adoption contract.
Can a Rescue representative visit your home now and in the future? Yes No
Is EVERYONE who lives in your household in agreement on getting a new pet?
Yes No If no, please explain
Personal References:
Please check the animal(s) you are applying to adopt: Dog Cat Other
If you've chosen the pet you want to adopt please list name
Please enter your email address
Thank you for your interest in a Real Rescue Inc. pet.
An adoption fee will be due upon adoption via In Home Placement Visit.
You will be required to sign a copy of this application certifying you are over the age of 18 years
and all information contained in this application is true to the best of your knowledge.
