RPSM is dedicated to finding the best homes for our once homeless pets. To make sure we meet this goal, we carefully examine all applications. We will check all personal references, veterinarians, landlords, and possibly do a personal background check. If you are serious about adopting a pet from our organization please complete this application in full.
All information on this application will be kept confidential.

If questions are left blank it may result in your application being discarded
To ensure your application will be received, please wait for the "Thank You for submitting..." message.

RPSM Adoption Application

Personal Information

Household Information

Pet History

Please list all animals you have owned in the last 7 years both living and deceased (Up to 4)

Please note: we are adamant about helping to reduce the pet overpopulation problem, we will not adopt to homes with pets that are intact (not spayed or neutered) unless there is a reasonable explanation as to why the animal is not altered. (i.e. conformation, medical, etc.)


Pet #1

Pet #2

Pet #3

Pet #4

Current Vet's Information

Pet Care Information

Personal References


Reference #1 (Non-Family Member)

Reference #2 (Non-Family Member)

Reference #3 (Family Member)

If you would like to be considered as a possible adopter for on of our rescued pets, please sign and date below.

To the best of my knowledge, all information that I have provided is complete and correct.  I here by accept responsibility for any/all illness that can occur. I release Refurbished Pets of Southern Michigan from any and all liability, now and in the future, from my voluntary action of adopting from any Refurbished Pets of Southern Michigan animal. I agree and consent to allow Refurbished Pets of Southern Michigan to contact my vet and obtain my pet’s records.