We thank you for your support!
Rocky Ridge Refuge is a 501c3 non-profit organization
If you would like to send a
check instead, my address is:
P.O. Box 105
Midway, Ar. 72651
Pet you are applying for (required)
Your Name (required)
Your Email (required)
Your Address (required)
Your Telephone Number (required)
Your Employer (required)
Your Occupation (required)
Will you allow a volunteer to do a home visit to determine if it is the best match for your family and the animal you are applying for? (required)
Do you live in a: (required)
Do you rent or own your home? (required)
Approximate sq. footage of home: (required)
Is your yard fenced? (required)
YesNoI do not have a yard
What is the height of your fence, what type fence do you have?
If you have no fence, how will the dog exercise?
Will the pet be restricted from any area of your home?
If yes, please explain
Number of adults in your home and their ages: (required)
Number of children in your home and their ages (required)
Is everyone in the household in full agreement with the adoption of this pet? (required)
If you renting, please fill out the following renters information
Are pets allowed?
Landlord's phone number
Have you discussed getting a pet with your landlord?
May I contact your landlord?
Your pets, past and present
Have you had any pets in the past 5 years?
If yes, please tell us about the pets you have owned in the past 5 years. Include age, breed, species and if they are indoor or outdoor pets. If you no longer have the pet, please let us know where they are now.
Are your pets on heartworm preventative as recommended by your veteranarian for your area?
Have you adopted from a rescue group before?
Will there be an adult home during the day with the pet?
How many hours a day will the pet be alone?
Where will the pet stay when home alone?
Where will the pet stay when you are home?
Where will the pet sleep at night?
Are you committed and prepared to support this pet for its lifetime, including through any unforseen and costly veterinary care?
If for any reason, you feel you must give up this pet, do you understand and agree that Rocky Ridge Refuge must be contacted and allowed time for arranging the return of the pet to their rescue?
Yes, I understand and agreeNo, I don't agree
Why do you wish to add this animal to your home? (required)
Can you briefly explain your philosophy/methods for teaching/training your dog the things it may still need to learn to be a successful companion (for example: any guidance it may need with housebreaking, walking on a leash or correcting behavior such as chewing, barking, jumping, etc.)
Any additional comments?
By choosing agree, you are affirming that all information provided on this form is true.