Typing your name in the box to the right is a legal digital signature
RPSM is dedicated to finding the best homes for our once homeless pets. To make sure we meet this goal, we carefully examine all applications. We will check all personal references, veterinarians, landlords, and possibly do a personal background check. If you are serious about adopting a pet from our group please complete this application IN FULL. If questions are left blank it may result in your application being discarded.
Please note; we are adamant about helping to reduce the pet overpopulation problem, we will not adopt to homes with pets that are intact (not spayed or neutered) unless there is a reasonable explanation as to why the animal is not altered. (i.e. conformation, medical, etc.)
Please fill in or check the suitable choices within this application Request
ALL INFORMATION ON THIS APPLICATION WILL BE KEPT CONFIDENTIAL
Date
Name
Address
City
State
Zip
Home
Phone
Cell
Phone
Email
Address
Occupation
Company
Work
Phone
Marital
Status
Roommates
Age
# Adults
# Children
Ages of Children
Rent Own
Type of
Dwelling
Home visit required
Landlords
name
Landlords
Ph #
Length
Renting
Previous
Landlords
name If less than 2 years
Landlords
name
Landlords
pH #
Will Pet be Family Pet
Is it
a Gift
If Gift
For Who
Does entire
Household want pet
Own Pet
Before
Pet Name&Type
Age&Sex
Spayed-Neutered
Still Have Pet
Please list all animals you have owned in the last
7 years both living and deceased
Where is pet now
Current Vets Name
Vets Address
Vet pH#
If adopting a dog, do you have a completely fenced
yard?
Do you have a kennel Run
Do you have a crate
Describe your crate, Size, Height, wire, plastic, mesh
Describe fence type, size, height
If you do not have a fence/kennel run how will you handle dogs potty times?
How many hours per day will the pet be left alone and where will it be housed while you are gone?
It may take several months for your new pet to adjust to its new home and family. How will you handle this?
How will you discipline your pet?
What behavior would cause you to return your pet to our rescue?
Are you willing to commit to owning a pet for the next 10+ years?
What is/are the names of the pets you are applying for?
To the best of my knowledge, all information provided is complete and correct. I agree and consent to allow Refurbished Pets of Southern Michigan to contact my vet and obtain my pet’s records.