Inquiries are reviewed within 48 hours. You will be contacted by either the foster or another member of Rebels Rescue. Please note: Our volunteers may contact you from their personal email address or phone number.
First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
County
Email*
Home Phone
Work Phone x
Cell Phone*
Text/Pager Email
Are you 21 years or older?
What is your occupation?*
Animal Name and Number you wish to adopt*
Why are you interested in adopting a pet at this time*
How much time will the animal spend alone during the day*
For cats only: Do you understand that you must never declaw your adopted cat or kitten? Choose one: Yes No
How many adults live in your home?*
Are there children in the home? If so please list the ages.*
Please list all the pets in your home. Include breed and age of each pet*
Have you ever given up a pet? If yes, please explain*
In what type of home do you live* Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing
Do you own or rent your home* Choose one: Rent Own
If you rent, have you received the approval of your landlord to have an animal? If you own, please select NA.* Choose one: Yes No NA
For Dogs, do you have a fenced yard ? If not how many walks do you plan on going on a day?
Current Veterinarian's Name and Phone Number (or one you plan on going to if you currently do not own a pet.)*
(Volunteer, Foster, Adopter) hereby agrees to hold Rebels Rescue, their officers, prior and current Directors, family members, harmless for any and all claims and agrees to waive all rights of subrogation against Rebels Rescue.
