Peace Love and Poms Rescue

First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County*

Country*

Email*

Home Phone*

Work Phone
x

Cell Phone*

Alt Email*

How did you hear about Peace Love & Poms Rescue?*

Is there a particular dog that caught your eye? If so, which one?*

Please provide your date of birth*

Do you have social media? If so, please provide the profile link.*

Please provide a brief description of the following, your occupation(s), employer(s) name and phone number, and a brief explanation of your daily schedule.*

List all people living in the residence. Please include: Name(s), Age(s), Relationship(s) to applicant*

If applicable, what is your spouse's name, occupation and work schedule?*

In what type of home do you reside? Single-Family Home, Apartment, Townhome/Condo*

Do you own or rent your home? If you rent, please provide the name and telephone number of your landlord.*

Do you have a pool? If so, is it inground or above-ground? Is it fenced or has another form of security?*

How long have you lived at your current residence?*

Do you plan to move in the next two years?*

Are all members of the residence in agreement of bringing a new dog into the home?*

Is anyone in the home afraid or allergic to dogs?*

Is your yard completely fenced? If so, describe material and fence height. If taking dog outside of secured yard, what safety measures are being taken?*

List all frequent visitors to the household. Please include: Age(s), Gender(s), Frequency Ex: Grandchildren, customers to your in-home-business, etc.*

List all animals currently living in your home and on your property. Please include: Name(s), Species/Breed(s) and, whether they are Spayed/Neutered.*

Have you ever owned a pet(s) before? Please provide the name(s), age(s), and years owned and the reason they are no longer with you.*

Please list pets in home belonging to someone else.*

What brand of dog food do you feed? Do pets free-feed or have scheduled feeding times?*

What types of treats or human food do you give your pets?*

Where will your adopted animal live? Access to whole home/yard, limited space in-home/yard, or a different living arrangement? If the animal will not have full access to the home/yard, please explain the expected living arrangement in greater detail.*

Where will the animal be when you are not home? (Ex. Crate, with other dogs, free-range in-home, etc.)*

How much time will the animal spend alone during the day? If more than 4 hours how will pet relieve themselves when alone?*

Where will the animal sleep?*

Are your pets allowed on your furniture? If not, why?*

Are you prepared to house-train your dog? How will you house-train? *

How will you discipline your dog?*

How will you help your dog transition? *Many of our dogs have never lived in a home and will need patience, consistency, and time to adjust to their new surroundings and really come out of their shell. *

What reasons would you rehome your pet? (i.e. Baby, moving, financial issues, etc.)*

Have you applied to other rescues recently? If so, were you approved, didn’t hear from them, or denied? Please explain.*

Are you willing to allow Peace Love & Poms to come to your home for a home-check?*

Please contact your veterinarian and give permission for them to discuss your records with our Adoption Coordinator. Please provide the name, address, and phone number of all veterinarians used during the last three years. NOTE: Failure to do so will result in a delay of application processing.*

References Please provide the name, relationship to the adopter, number of years known, and phone number of two references.*