RCPA! Adoption Application
This application is the property of RCPA! and we reserve the right to refuse adoption to anyone.
To adopt a pet from Rusk County Pets Alive! please ensure the following:
- Be at least 21 years of age
- Have a form of identification (driver's license or state ID)
- Verify that you are allowed to have a dog or live with any restrictions for dogs
- Current pets must be spayed/neutered
- A fenced yard may be required for the dog you are interested in
- Training may be required for the dog you are interested in
- RCPA! may check veterinarian and personal references
- Bring along all household members including children and current dogs to meet the pet
Emergency Contact Name and Phone Number
Name of dog or cat you would like to adopt
Has anyone in your household been charged with or cited for any kind of animal cruelty or neglect?
Do you understand we are looking for the ideal home placement of our animals, and we may not approve your adoption of this dog?
● 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
● I understand that a home check may be required prior to or following adoption
● I understand and agree that the care, feeding, training, and well-being of the animal are adult 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.
● If upon home check, random home visit, application review or veterinary reference checks, Rusk County Pets Alive! finds information contained in this application to be false, Rusk County Pets Alive! remains the right to turn
down the adoption or remove the animal from your premises without a refund of paid adoption fees.
Your typed name indicates a digital signature:
Co-Applicant typed name working as a signature:
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service