Rescuing Animals In Need, Inc.
Adoption Screening Form

Date:  __________ Animal’s Name:_______________ Cat ___ Dog ___ Foster __________________

Adopter’s Name:  ____________________________________________________________________

Address: 	     ____________________________________________________________________

City                      _____________________________ST_________________Zip_______________

Home Phone:       ____________________________ Work Phone: _____________________________

Emergency Contact/Reference Name: ______________________Phone #________________________          

Do you:   Own ___  Rent ___  Landlord’s Name ________________________ Phone______________

Number of adults in household       _________   Number of children in household    _________  
Has everyone in the household agree to take on the responsibility of this animal? Yes ____  No ____
                    (all family members, roommates etc. must agree to adopt this pet)

Is anyone in the household allergic to pets?  Yes ____  No ____  (if yes, how will the allergies be handled?)
Is this an impulse adoption?                           Yes ____   No ____
                                (if an impulse decision, explain the importance of considering this commitment)
Is this adoption a gift for someone else?        Yes ____  No ____

What types of pets do you have now?  Cats # ____  Dogs # ____  Other _____________
Are your cats declawed?                                Yes ____     No _____   Not Applicable ____
Are your pets’ spayed/neutered?                    Yes ____     No _____
Have you had this type of pet before?            Yes ____     No ____
(If yes, what happened to it?/ still have?) __________________________________________________
Where do your cats live?                       Indoors ____   Outdoors ____    Both ____ 
Where will this pet live?                        Indoors ____   Outdoors ____    Both ____ 
If you are adopting a cat/kitten, will he/she be declawed?      Yes ____ No ____ Maybe ____ 
Would you like more information on declawing?                   Yes ____ No ____
How long do you intend to keep this animal? _______________________________________________
If you move, are you willing to bring this animal to live with you in your new residence?
                                                    Yes ____  No ____  Maybe, if the apartment complex allows pets ____
Most shelter animals have unknown medical backgrounds. Once you take possession of this animal, are you prepared 
to take the animal to a licensed veterinarian for regular check-ups and any other necessary medical treatment at your 
expense? Yes__ NO___
Who is/will be your veterinarian? ________________________________________________________

Are you prepared for the costs of owning a pet?:  Including food, litter, yearly vaccinations, medical                                                                                
care, grooming etc.   Yes ____  No ____
Are you aware that this animal requires a lifetime commitment and that this animal may live 20 years or longer?                           
Yes ____   No ____
R.A.I.N.’s adoption policy states that if the adoption does not work out for some reason, you agree to return the animal to us.  
Will you comply?       Yes ____  No ____ Maybe ____
R.A.I.N’s funds are very tight, due to the high cost of veterinarians. Therefore, we have a “no refund” policy.  Is this 
acceptable to you?   Yes _____	No _____
Do you agree to participate in follow-up calls and/or visits from R.A.I.N. volunteers/representatives?  Yes____  No______

I hereby confirm that the information supplied here is truthful. I understand that Rescuing Animals In Need, Inc. (RAIN) may 
refuse adoption for any reason or may confiscate an animal at any time, if the information given here is deemed incorrect or if 
the animal is not being cared for properly. I further understand that if I cannot keep this animal for any reason, I will contact 
Rescuing Animals In Need and make arrangements to return the animal, so that RAIN places the animal in another suitable 
home.

Signature: ______________________________________________________  Date: _____________
(R.A.I.N. use only)
Application Approved ____ Denied ____  Reason for Denial? ________________________________