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RCPA Dog Adoption Application
This application is the property of RCPA! and we reserve the right to refuse adoption to anyone. 

To adopt a dog from Rusk county Pets Alive please ensure the following:
--Be at least 21 years of age.
--Have a form of identification (drivers license or state ID)
--Verify that you are allowed to have a pet at your residence
--Current pets must be spayed/neutered
--A fenced yard may be required for a dog you are interested in
---RCPA may check vet references
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Email *
Name *
Phone Number *
Address *
City, State, Zip Code *
Alternate Contact Name & Number *
Dog interested in Adopting
If you are not applying for a specific dog, what size dog are you interested in? Small 10-15 lbs, Medium  15-30 lbs, Large 40+ lbs?
What energy level are you looking for? Couch potato, daily walker, runner/active?
Other pets?
● I, the undersigned, certify that the information contained in this form is true and correct.
● I hereby release to Rusk County Pets Alive! all veterinary records of any and all animals I have had or currently have.
● I understand and agree that the care, feeding, training, and well-being of the animal are my responsibilities.
● I understand that I may not be able to adopt the pet I have chosen if this animal would not be a good match due to lifestyle or housing concerns.
● This application remains the property of Rusk County Pets Alive!.
● Rusk County Pets Alive! reserves the right to refuse adoption to anyone.
** In consideration of receiving this animal, I hereby release RCPA, its officers, agents and volunteers from all claims of injury or damage which this dog may cause the adopter or the adopter's property.  I hold harmless, defend and indemnify RCPA from any and all claims of liability to other persons for injuries or damage arising out of or in connection with services of this program or caused to them by this adopted dog. 

Your typed name is your agreement to our policies. *
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