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*Name:

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*Address:

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E-mail:

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*Phone:  Home:                          

               Work:                           

               Cell:

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Please list ages of all persons living in your home:

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Please list  your pets by breed, age and name:

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Do your animals live inside/outside?

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Veterinarian name/phone #:

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Why do you want to adopt Rita?

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Please describe where she will be during the day/ night and whether you have a fenced yard:

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Please list two references and contact #s:

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I cannot guarantee the behavior of Rita. I can tell you what I have witnessed; I have only had her for a few weeks and cannot predict everything. Although she appears to be pretty well housebroken, a change in venue might produce at least a temporary “relapse.” It would be wise, at first, to keep her confined to an easily cleanable area, such as a kitchen or bathroom.

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In order to adopt Rita, you must agree to hold harmless and release us, from any and all liability related to physical injury or property damage to you, your pets, your family or others by Rita. Please separate new pets from your animals and children until you are able to supervise safe interaction.

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