Welcome to PMR&R

Adoption Application Form

Contact Information

First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
-

Email*

Home Phone

Work Phone
x

Cell Phone

Alt Email

Text/Pager Email

*=required

Spouse/Co Applicant Name

Enter your age and the age of co-applicant*

Please list you Employer/Spouse Employer and a contact number*

Please list the names and ages of any children living in your home, or "None" if there are no children in your home.*

If you don't have children, do you plan on having children someday? (Choose N/A if you listed children above)

Yes

Does anybody else live in your home? If Yes, please list their names and ages.*

Does any household member suffer from asthma or allergies? If yes, please describe.*

In what type of home do you live?

Single Family	Duplex
Apartment	Townhouse
Condominium	Mobile Home
Military Housing

Type of Environment

City	Country
Suburbs

Do you rent or own?

Rent

Own

If you rent, please enter your landlord's name and phone number. If you own, please enter "N/A".

If you rent, have you received the approval of your landlord to have an animal? If you own, please enter "N/A".

Is your front or back yard fenced?*

Is there a chance that you might move in the next 10 years?

Yes

If so, are you willing to restrict your choice of housing to places where a dog is allowed?

Yes

Which dog/s are you interested in?*

*=required

What traits are you looking for in a pet

Male	Female
Baby	Young
Adult	Companion
Protective	Companion for Another Pet

Where will the dog be kept?

Inside Only	Outside Only
Inside and Outside

Where will the animal sleep at night?*

How much time will the animal spend alone during the day*

Where will the animal be kept when you are not home*

What ongoing behavior, if not fixable with time, could you not tolerate in a dog?

Aggression	Marking
Barking	Rough Play
Food Aggression	Severe Shyness
Submissive Peeing	Health Problems
Hyperness	Jumping
Chewing	None

Do you understand that the dog will take time to adjust to its new surroundings and that certain behavioral issues might occur?

Yes

Are you willing to work with the dog to correct these issues?

Yes

Under what circumstances might you want to return the dog? (Examples: Marriage, new baby, divorce, behavior issues, financial stress, job change etc.)*

*=required

Will you take your new dog to a basic obedience class? This is required for ALL puppies and some adult dogs.*

Veterinarian's Name and Phone Number (or N/A if you do not currently have a vet, or have not had one recently).*

Do you have any pets currently? If yes, please list name, age, sex, species, and breed.*

Are your current pets on heartworm and/or flea preventative? If no pets choose N/A

Heartworm Preventative	Flea Preventative
Both	None
N/A

Are your pets current on all shots? If no pets, please choose "N/A".

Yes

Are your pets spayed/neutered? *

List all the pets you have owned in the past 10 years and what happened to them:*

Where do your currently owned dogs stay when you are not home?

Inside Only	Outside Only
Inside and Outside

What do you enjoy most about dog ownership?*

What do you like least about dog ownership?*

Please list the names and email address or telephone #'s of 3 references not related to you. If you do not currently have pets under vet care please provide a fourth reference.*

Have you adopted from Pawfect Match before?

Yes

Have you met with PMR volunteer, at local event, who did you meet with. Have you met any of the dogs you may be interested in?*

Have you applied with any other rescue? If yes, please list*

I certify that the information entered on this applicant is true. Enter your name and date*

*=required

The critical work of Pawfect Match^TM is to ensure the care and health of our animals. If you are seeking a way to help the animals in our care we would be grateful for your financial support. There are several ways you could support our mission. Aside from volunteering we do have a PayPal set up for monetary donations as well as an Amazon Wishlist! Our highest needs right now are puppy pads, dry puppy food, dog toys, paper towels, hand sanitizer, crates and/or puppy pens. Your support is greatly appreciated.