Name
Email Address:
Address: Street, City, State and Zip Code
Which dog(s) are you interested in?
Why do you want this particular dog(s)?
Home Phone (with area code)
Cell Phone (with area code)
Business Phone (with 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
Lease
Other
If Renting, Leasing or living in a House or Condo with HOA do you have permission to have a dog? Yes
No
If you Rent, Lease or live in a property with HOA please provide Landlord or HOA contact Name and Phone Number;
How long have you lived at this address?
If you are in an Apartment or Condo or property with HOA what is the Pet Weight Limit?
Will the dog be an indoor or outdoor pet? Indoor
Outdoor
Both
Approximately how many hours a day will this dog be inside?
Approximately how many hours a day will this dog be outside?
Approximately how many hours a day will this dog be left alone (without human interaction)?
Will the dog be allowed on the furniture? Yes
No
Will some furniture be off limits? Yes
No
If yes what furniture will be off limits?
Will the dog be allowed in all areas of the house? Yes
No
If no, which areas will be off limits?
Where will the dog sleep at night (check all that apply)? Dog house outside
Dog bed inside home
Crate inside home
Bedroom
Garage
Other
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 leash
Off leash
Both
If off leash, where?
Do you have a backyard or garden area? Yes
No
If yes, is your backyard or garden area fenced? Yes
No
If yes, what is the height of the fence?
If yes, what is the type of fence?
If yes, do you have latched gates? Yes
No
If yes, do you have locked gates? Yes
No
Do you have a pool, jacuzzi or pond? Yes
No
If yes, is it fenced separately from the area to which the dog would have access? Yes
No
Will this be your first dog? Yes
No
Are all other pets spayed or neutered? Yes
No
If you have cat(s), are they: Indoor
Outdoor
Both indoor/outdoor

PLEASE LIST YOUR PETS BEGINNING WITH THOSE YOU CURRENTLY OWN AND GOING BACK 7 YEARS.

Pet #1 Species or Breed: Male or female Name of Pet: Length of Ownership: Do you still own this pet? If yes, how old is this pet? If no, what happened to this pet?
Pet #2 Species or Breed: Male or female Name of Pet: Length of Ownership: Do you still own this pet? If yes, how old is this pet? If no, what happened to this pet?
Pet #3 Species or Breed: Male or female Name of Pet: Length of Ownership: Do you still own this pet? If yes, how old is this pet? If no, what happened to this pet?
List your current veterinarian information: Name of Vet or Practice: Address; Street, City, State & Zip Code Phone number (with area code)
If you travel who will care for your dog (pets) when you are away?
What is a reasonable amount to spend at the vets if your dog became sick or injured?
Do you currently have or would you consider getting pet insurance?
Does anyone in your home have animal related allergies? Yes
No
If yes, who is allergic and to what?
How will you train this dog? Obediance school
Spray bottle
Firm verbal commands
Swat with newspaper
Other
If other please explain:
Are you willing to housetrain a dog? Yes
No
If yes, using 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 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
If no, please explain why not:
Have you ever been in a situation where you were not able to keep a pet? Yes
No
If yes, please explain:
Have you ever been in a situation where you had to bring a dog to the shelter? Yes
No
If yes, please explain:
Are you prepared and able to take care of this dog for his/her entire lifetime? Yes
No
Do you have friend(s) or relative(s) who would facilitate returning the dog to Nor Cal Pom Rescue if you became unable to care for it? Yes
No
If yes, please list their name and phone number:
Please estimate the annual cost of dog food, toys, vet care, grooming and etc. for your new pet: $
What circumstance would cause you to give up a pet?
The adoption fee is to partially recover costs involved in rescuing this and other dog(s). These costs include but are not limited to Shelter pull fees, spay/neuter, vaccinations, de-worming, microchip and vet exams the dog(s) may require. We would not have been able to save the life of the dog you applied to adopt without adoption fees from another that came before him/her. Are you willing and able to pay the adoption fee?
If no, please explain why not:
Nor Cal Pom Rescue reserves the right to inspect all potential homes and yards prior to placement. Is this agreeable to you? Yes
No
I have read the questions carefully and have responded 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 Nor Cal Pom Rescue has the right to annul the adoption and reclaim the dog. This application becomes part of the adoption contract. I agree
I disagree

Create a web form here