Adoption Application

POM TO THE RESCUE

ADOPTION APPLICATION

If you have problems accessing this application, please contact our webmaster for help.

Please answer each and every question and be truthful and candid in your answers. No answer is wrong. The application gives us a starting point to determine the best possible placement for each beloved rescue. We at Pom to the Rescue strive to find the best match possible to ensure that our rescues will never be in need of rescue again in their short lives. Once we have made a final decision regarding an application we do not respond to email requests as to what our reason(s) for denial, or give a reason(s) for our ascertainment. It takes too much time away from what is most important ~ the rescues! We hope you understand and respect our final decision.

IMPORTANT~ Any question left blank or given a partial answer, such as the address, results in an automatic decline! We only adopt locally.

Name:

Email Address:

Which dog(s) are you interested in?

Why did you choose this particular dog(s)?

Address(street,city,state and zip code):

Home phone number (include area code):

Cell phone number (include area code):

Occupation:

Employer:

Please list all members of your household (including ages):

Type of home: House
Apartment
Condo
Mobile Home
Other

Do you- Own
Rent

If renting, do you have your landlord's permission to have a dog? Yes
No

Landord or HOA name and phone number (Required if you rent):

How long have you lived at this address?

If you live in an apartment or condo., what is the pet weight limit?

Will the dog be an indoor or outdoor pet? Inside
Outside
Both

How many hours a day will this dog be outside?

How many hours a day will the dog be left alone?

Will some furniture in the home be off limits? Yes
No

If yes, what furniture?

Will the dog be allowed in all areas of the house? Yes
No

If no, what areas are limited?

Where will the dog sleep at night?

Will you give your dog people food? Yes
No

What type of exercise will you provide?

Will you walk/exercise this dog on or off leash? On
Off
Both

If off leash, where?

Do you have a backyard? Yes
No

Is your backyard fenced? (if applies) Yes
No

Height of fence:

Type of fence:

Latched gates: Yes
No

Locked gates: Yes
No

Do you have a pool? Yes
No

If yes, is it fenced? Yes
No

Will this be your first dog?

Are all other pets spayed or neutered? Yes
No

If you have cat(s) are they: Indoor
Outdoor

If you have cat(s) are they de-clawed? Yes
No

If yes, please explain why:

Please list all pets currently living in the home (include type of pet):

Have you ever been in a situation where you were not able to keep a pet? Yes
No

If yes, please explain:

If you travel, do you have someone to care for your pet? Yes
No

Veterinary information (name, address, city, state, zip and phone number):

What is a reasonable amount of money to spend on your dog if he became very sick?

Does anyone living in your home have animal related allergies? Yes
No

If yes, who and to what?

How will you train this dog?

Are you willing to housetrain a dog? Yes
No

If yes, what method?

What will you do if the dog has accidents in the house?

Do you understand and accept that a change in a dog's environment may cause the dog to have accidents, especially in the early days of the adoption? Yes
No

What will you do if the dog chews, or has other bad habits?

Do you plan to take your new dog to obedience school? Yes
No

Are you prepared to take care of this dog for his/her lifetime? Yes
No

Do you agree to return this dog to Pom to the Rescue if you became unable to care for it? Yes
No

Please estimate the annual cost of dog food, toys, vet care, grooming, teeth cleaning, etc. for your new pet:

We are a non-profit org. The adoption donation is used to partially recover the costs involved in rescuing this dog. These costs include but are not limited to: Shelter fees, spay/neuter, housing, vacc., de-worming, micro chip, teeth cleaning, and any exams or medical care that the dog may have required. We would not have been able to save the life of the dog you applied for without the adoption donation from another that came before him/her. Are you willing and able to make the donation fee? Yes
No

If no, please explain why:

What circumstance would cause you to give up a pet?

We reserve the right to inspect all potential homes and yards prior to placement. Is this agreeable to you? Yes
No

I have read the above carefully and have filled out this application honestly. I understand that an omission and/or failure to answer all questions can result in the application being declined. If an omission or untruth is discovered after an adoption takes place, I understand that Pom to the Rescue has the right to annul the adoption and reclaim the dog. This application becomes part of the adoption contract. I agree
I disagree

Form provided by Freedback.

Name:
Email Address:
Which dog(s) are you interested in?
Why did you choose this particular dog(s)?
Address(street,city,state and zip code):
Home phone number (include area code):
Cell phone number (include area code):
Occupation:
Employer:
Please list all members of your household (including ages):
Type of home:	House Apartment Condo Mobile Home Other
Do you-	Own Rent
If renting, do you have your landlord's permission to have a dog?	Yes No
Landord or HOA name and phone number (Required if you rent):
How long have you lived at this address?
If you live in an apartment or condo., what is the pet weight limit?
Will the dog be an indoor or outdoor pet?	Inside Outside Both
How many hours a day will this dog be outside?
How many hours a day will the dog be left alone?
Will some furniture in the home be off limits?	Yes No
If yes, what furniture?
Will the dog be allowed in all areas of the house?	Yes No
If no, what areas are limited?
Where will the dog sleep at night?
Will you give your dog people food?	Yes No
What type of exercise will you provide?
Will you walk/exercise this dog on or off leash?	On Off Both
If off leash, where?
Do you have a backyard?	Yes No
Is your backyard fenced? (if applies)	Yes No
Height of fence:
Type of fence:
Latched gates:	Yes No
Locked gates:	Yes No
Do you have a pool?	Yes No
If yes, is it fenced?	Yes No
Will this be your first dog?
Are all other pets spayed or neutered?	Yes No
If you have cat(s) are they:	Indoor Outdoor
If you have cat(s) are they de-clawed?	Yes No
If yes, please explain why:
Please list all pets currently living in the home (include type of pet):
Have you ever been in a situation where you were not able to keep a pet?	Yes No
If yes, please explain:
If you travel, do you have someone to care for your pet?	Yes No
Veterinary information (name, address, city, state, zip and phone number):
What is a reasonable amount of money to spend on your dog if he became very sick?
Does anyone living in your home have animal related allergies?	Yes No
If yes, who and to what?
How will you train this dog?
Are you willing to housetrain a dog?	Yes No
If yes, what method?
What will you do if the dog has accidents in the house?
Do you understand and accept that a change in a dog's environment may cause the dog to have accidents, especially in the early days of the adoption?	Yes No
What will you do if the dog chews, or has other bad habits?
Do you plan to take your new dog to obedience school?	Yes No
Are you prepared to take care of this dog for his/her lifetime?	Yes No
Do you agree to return this dog to Pom to the Rescue if you became unable to care for it?	Yes No
Please estimate the annual cost of dog food, toys, vet care, grooming, teeth cleaning, etc. for your new pet:
We are a non-profit org. The adoption donation is used to partially recover the costs involved in rescuing this dog. These costs include but are not limited to: Shelter fees, spay/neuter, housing, vacc., de-worming, micro chip, teeth cleaning, and any exams or medical care that the dog may have required. We would not have been able to save the life of the dog you applied for without the adoption donation from another that came before him/her. Are you willing and able to make the donation fee?	Yes No
If no, please explain why:
What circumstance would cause you to give up a pet?
We reserve the right to inspect all potential homes and yards prior to placement. Is this agreeable to you?	Yes No
I have read the above carefully and have filled out this application honestly. I understand that an omission and/or failure to answer all questions can result in the application being declined. If an omission or untruth is discovered after an adoption takes place, I understand that Pom to the Rescue has the right to annul the adoption and reclaim the dog. This application becomes part of the adoption contract.	I agree I disagree