Adoption Form (online)

RSVP inc. Animal Welfare & Rescue Group Adoption Application Form

RSVPinc. Responsible Solutions for Valued Pets, P.O. Box 335, Eastport, NY 11941, (631) 533-2738 info@rsvpinc.org

Date: *

Name *

First

Last

Street Address: *

City, State, Zip Code *

Mailing Address: *

Address is the same as above
Different, will add below

Mailing Address:

City, State, Zip Code

Email *

Phone Number: (Cell)

Phone (Home)

Phone Number: (Work)

Current or Last Employer: *

Occupation: *

Spouses Name/ Roommates Name

First

Last

Number of Household Members: *

Ages: *

Any Allergies? *

Own or Rent home *

If you rent, please provide landlords name and phone number:

If you rent, does your lease permit you to have pets?

If you rent, does you lease limit size or number of pets?

If you selected other, please explain:

What animal are you interested in adopting? *

Are you adopting this animal as a companion for yourself? *

If no, please for whom?

Where will you keep your new pet? *

How many hours a day will the pet be left alone? *

Where will the pet be kept during this time? *

How will you provide for this animal’s exercise and elimination needs? *

What will you do if you move or your situation changes? *

Do you agree to accept full responsibility for all veterinary care for this animal’s lifetime? *

Do you currently have any pets? *

If yes, please describe (type of pet, name, age, sex):

Are they spayed or neutered?

If no, why not?

Is their veterinary care up to date?

Veterinarian’s Name and phone number: *

Have you had pets in the past? *

If yes, when, how many, what type of pet?

If yes, where did you get your pet?

If yes, where are they now?

Please list three personal references with phone numbers: (1) *

First

Last

Relationship: *

Contact Number: *

Please list three personal references with phone numbers: (2) *

First

Last

Relationship: *

Contact Number *

Please list three personal references with phone numbers: (3) *

First

Last

Relationship: *

Contact Number: *

I hereby give permission for RSVP to contact above mentioned references. Please sign below to authorize contact: *

I hereby declare all information provided in this application to be accurate and understand any false information will lead to the failure of adoption: Please sign to declare all information to be accurate: *

Date: *

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