You have expressed an interest in acquiring a Pomeranian dog which will be placed by the Pomeranian Club of Central Indiana, Rescue Committee according to the conditions set forth in this Agreement. Please complete the following information in order that the committee can find a suitable Pom for you and your family.
Name:_______________________________________________________________
Address:____________________________________________________________
City:______________, State:______ Zip Code:________________________
Phone Number:_______________________________________________________
E-Mail Address:_____________________________________________________
Have you ever owned a Pom?: yes no Other dog?: yes no
What happened to it/them?: __________________________________________ _____________________________________________________________________
Animals currently owned?: ___________________________________________
Are any of these animals spayed/neutered? yes no
What do you know about the breed?: _____________________________________________________ _____________________________________________________________________
Do you have a fenced yard?: yes no live in an apartment
Would you be willing to provide a fence or run?: yes no live in an apartment
If no, WHY?____________________________________________
How many children do you have?:________ Ages?: ____________________
Number of adults in the household?:_______ Is someone home during the day?: yes no
Who will take responsibility for the dog?: _______________________________________________
Will the dog live indoors or outside?: indoors outside
If you rent your home please supply the address and phone number of your landlord: ___________________________________________________________
Have you thought about care for the dog when the family is on vacation?: yes no
Do you have a preference for a male or female?: no preference male female
Do you have a size preference?: no preference 3-8 pounds over 8 pounds
Are you a member of any dog clubs?: _________________________________
Would you consider a "special needs" pom? yes no
(meaning one who may have a condition that needs daily medication)
Are you prepared for the expense of veterinary care and feeding the dog?: yes no
______________________________________________________________________________________________________________
Who is/or will be your veternarian?_________________________________
Vets Phone#_________________________________________________________
Standard Adoption fee is the price of the vet bill. It is NON-REFUNDABLE!!
If for ANY reason this dog does not work out, it MUST be returned to the Club. NO EXCEPTIONS!!!!
If it is feasible, a in-home interview will be done before placement of this pom.
This is done so we may meet you and ALL members of your family as well as see the kind of home this pomeranian will have.
Adopting Person:X_______________________________________________________
Rescue Coodinator:X_____________________________________________________
Please print it out and mail to Kelley Scott 58941 Beech Rd. Mishawaka, Indiana 46544