Adoption Applications

To start the adoption process, please fill out the questionnaire below. A volunteer from Riverside Rescue will contact you directly.

If you would prefer to mail the adoption application, please contact us.

* Indicates a required field

Animal Name You'd Like to Adopt:	*

Applicant Name (First & Last):	*
Spouse Name (First & Last):

Home Street Address:	*
Home City:	*
Home State:	*
Home Zip:	*
Over 21 years old?	*

E-Mail:	*
Telephone:	*
Mobile:

Do you own or rent?	*
Landlord Name (if applicable):
Landlord Telephone (if applicable)?
How long have you been at this residence?	*

How many daily hours are you away from home?	*
Where will the pet be while you are away?	*

Do you have children?	*
What are their ages?

Is anyone allergic to animals?	*

Employer Name:	*
Employer Telephone:	*

Why do you want to adopt this pet?	*

Veterinarian's Name:	*
Veterinarian's Telephone:	*

Tell us about other pets you currently own or have owned in the past 5 years: *

Check here if you have never had pets before

Name	Breed/type	Age	Sex	Spay/Neuter	Still Have?

List Two Personal References

Name:	*
Telephone:	*

Name:	*
Telephone:	*

Adoptions cannot be finalized or guaranteed online. By clicking submit,
you are authorizing Riverside Rescue to contact employers and references.