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RESPONSIBLE PET OWNERS ALLIANCE
APPLICATION FOR ANIMAL ADOPTION
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All animals adopted through the RPOA Animal Education, Rescue and
Adoption Program must be spayed/neutered. Dogs will be certified as heartworm negative when adopted and must be kept on heartworm preventive medication after adoption.
There is an adoption fee of $_____________
Breed or Species
____________________________________________________
Do you have children? _______
If yes, specify age(s)_________________________
Do you have other pets? _______
If yes, specify type, sex etc. _________________
Current veterinarian? __________________________________________________
Do you have a fenced yard? __________ If not, exercise program? _______________
To be kept indoors?__________Outdoors?__________Shelter?___________________
Do you live in a house, apartment, condo, or mobile home? _______________________
If leasing, is there a weight limit on dogs? __________________________________
Will you keep a collar and tag with proper ID on your pet? _____________________
Are you familiar with animal regulations in your area? ________
Do you have a preference as to MALE?________FEMALE?____________________
Color?_______ Age?______ Older dog O.K?_____
Short coat ?___ Long coat?___
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Responsible Pet
Owners Alliance makes no claim or representations as to the temperament, health, or mental disposition/personality of any animal available for adoption. I agree to indemnify and
hold harmless Responsible Pet Owners Alliance, the individual rescue agent and/or group from any claims arising from this adoption.
DATE:________________
NAME:________________________________________
ADDRESS:_____________________________________
CITY/STATE/ZIP:_______________________________
HOME PHONE:______________________WORK PHONE:______________________
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