Status_______________________________
Pampered POMS Rescue
Status____________________ Requirements________________________________
Landlord Check____________ Vet Check_________
Animal___________________ Yard Check_________________________________
In order to be considered for an adoption today, you must: Be 21 years of age
Have the knowledge and consent of all adults living in your household * Have a valid ID with current address * Have landlord’s name and telephone number (or lease) * Understand that Pampered POMS Rescue must approve your application (based on our policies .) If several people apply for the same pet we will chose the best match.
Name:__________________________________________________________________
Address:________________________________________________________________
City:_____________________________________State:_______Zip:___________
Phone:______________________ Age:______
Email Address: ________________________________________________________
Employment___________________________________________________________
1. What type of pet are you looking for?
DOG MALE FEMALE ADULT PUPPY Size:____
2. Do you want a particular breed? If yes, what breed?________________________
3. Do you want this pet for: COMPANION PROTECTION BREEDING GIFT ______________ OTHER__________________________
4. This pet will be without human companionship for about ____________ hours
per day, ______________days per week.
A. What does your daily schedule look like? Who will be home with the pet?
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
B. Who will be the pet’s primary companion?_________________________
5. Where will your pet be kept during the day? (circle all that apply)
INDOORS OUTDOORS DOG PEN CRATE
OTHER _______
During the night? INDOORS OUTDOORS DOG PEN CRATE
OTHER________________________
Page 2.
6. Where do you live? ___HOUSE __ APARTMENT __CONDO __TRAILER
__I RENT___I OWN __With Parents
7. Landlord’s name: _____________________________Phone:________________
8. Does your landlord allow pets? YES NO DON’T KNOW
Deposit required? ____________________ Monthly rent increase?___________
9. Do you have a fenced yard? YES NO
If fenced, please describe the height and type:____________________________
10. Please provide the following information about your household:
Number of adults: _______ Number of children:_____ Child Ages:___________
11. Is anyone in your family allergic to animals?_____________ CATS DOGS
12. What will you do with your pets if you move in the future:_________________
13. How much do you anticipate spending yearly to feed, vaccinate, license and
provide medical care for your pet?______________________________________
14. Would you be willing to allow a representative from the rescue visit your home
before the adoption is completed?______________________________________
15. What kind of diet do you feed your dogs? Brand of kibble/wet food? __________
16. Are you going to cook for your pet? ______ or feed raw? ____
17. Would you consider a food that we have chosen for this pet?_____________
18. What type(s) of pets (and the ages) do you own now? ___________________________________________________________
19. Are they neutered? ____________________
20. Who is your veterinarian for your current pets?
Name:________________________________Phone:_______________________
18. Do you realize that a dog or cat may live 15 or more years? YES NO
19. It may take your new pet two or more weeks to adjust to its new home, especially
if other pets are involved. Are you prepared to allow this much time? YES NO
20. How do you plan to house train your dog?______________________________
________________________________________________________________
By signing below, I certify that the information I have given is true and that I recognize that any misrepresentation of the facts may result in my losing privilege of adopting a pet. I authorize investigation of all statements on this application. I understand that this application is property of the Pampered POMS Rescue.
If this pet needs us again, at any point in his (or her) life, we will accept it, at no charge.
Adoptions include free grooming, boarding and day care for three months.
WE DO NOT ACCEPT CREDIT OR DEBIT CARDS. CASH OR CHECK ONLY.
Signature:_____________________________________________Date:______________
Application may be sent to: pamperedpawsinkc@
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