Pacific Coast Dog Rescue: Online Adoption Application

Click on the "DONATE" button below to submit your $250 adoption fee,
or simply to make a donation using your credit card.

Thank you for your interest in adopting a PCDR dog! Please take time to complete the application below thoroughly. Adopting a dog is a lifelong commitment, and we want to make sure the dog that has caught your eye will make a great match for you and your family. There are no right or wrong answers – your honest responses will help us guide you to the best dog for your unique situation. If you'd rather print this application, click here.
Dog(s) of Interest
Personal Information
Your Full Name
Spouse/Partner Name
Street Address
City
State		Zip
Home Phone w/ Area Code		Work Phone w/ Area Code
Mobile Phone w/ Area Code
Email Address
Please Confirm Your Email Address
Your Occupation
Partner/Spouse's Occupation
Work Schedule
Partner/Spouse's Work Schedule
Your Home
Type of Dwelling		Do You ...
Length of Time in Current Residence
If you rent or lease, do you have landlord's permission to have a dog?	Yes No
Have you asked your landlord if there are size or breed restrictions?	Yes No
If your Landlord has size or breed restrictions, please explain:	Use as much space as you need.
Landlord's Name
Landlord's Phone Number
Does your home/apt have a pool?	Yes No	Is yes, is it fenced?	Yes No
Will the dog have access to the pool?	Yes No
Do you have a fenced yard, patio or other area that the dog will have unsupervised access to?	Yes No
If yes to the above, please describe the fence, materials, height, locks.	Use as much space as you need.
Does anyone have access to your yard when you are not at home? (i.e., gardener, meter reader)	Yes No
May a rescue volunteer visit your home and see the area(s) where the dog will be staying?	Yes No
Your Pet History
Do you presently have a dog?	Yes No	Have you previously had a dog?	Yes No
CURRENT DOG(S) INFO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - >
Current Dog #1 - Type of dog (breed)
Age		Sex
Altered? (spayed/neutered)	Yes No
How & where obtained?	Use as much space as you need.
How long with you?	Use as much space as you need.

Current Dog #2 - Type of dog (breed)
Age		Sex
Altered? (spayed/neutered)	Yes No
How & where obtained?	Use as much space as you need.
How long with you?	Use as much space as you need.

PREVIOUS DOG(S) INFO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - >
#1 Previous Dog Type (Breed)
Age		Sex
Altered? (spayed/neutered)	Yes No
How & where obtained?	Use as much space as you need.
How long with you?	Use as much space as you need.
Why you no longer have the dog:	Use as much space as you need.

#2 Previous Dog Type (Breed)
Age		Sex
Altered? (spayed/neutered)	Yes No
How long with you?	Use as much space as you need.
Why you no longer have the dog:	Use as much space as you need.

Have any of your dogs ever had puppies?	Yes No
If yes to above, breeding was for...
Do you or any member of your family/household have any animal-related allergies?	Yes No
If you answered yes to the above, please describe:	Use as much space as you need.
Have you ever trained a dog in obedience class?	Yes No
Have you ever trained a dog yourself?	Yes No
Do you have a current Veterinarian?	Yes No
If yes, veterinarian's name
If yes, veterinarian's phone number

OTHER PETS - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - >
Other Pet #1 - Species (cat, bird, reptile, etc.)
How and when obtained:	Use as much space as you need.
Age	Spayed/Neutered?	Yes No
Kept where:	Use as much space as you need.

Other Pet #2 - Species (cat, bird, reptile, etc.)
How and when obtained:	Use as much space as you need.
Age	Spayed/Neutered?	Yes No
Kept where:	Use as much space as you need.
Your New Pet
What is your primary reason for adopting a dog?
If "OTHER", please describe:	Use as much space as you need.
Who will be the primary caretaker/companion of the dog?
If "OTHER", please describe:	Use as much space as you need.
Where will the dog sleep?	Use as much space as you need.
How many hours per day will the dog be left alone?	Use as much space as you need.
Where will the dog be when he/she is alone?	Use as much space as you need.
Where will the dog be when you are at home?	Use as much space as you need.
Are there areas of the house that are "Off Limits" to the dog?	Use as much space as you need.
Do you have a doggie door?	Yes No
If you have a doggie door, does it provide access to the entire house or a confined room/area?	Use as much space as you need.
How will you exercise the dog?	Use as much space as you need.
How will you obedience train the dog?	Use as much space as you need.
If necessary, would you be willing to hire a trainer to help with obedience problems?	Yes No
When you are away from home on vacation or for work travel, what provisions will be made for the dog?	Use as much space as you need.
Under WHAT circumstances would you NOT keep the dog? Check all that apply.	Divorce Illness in Family Moving New Baby Dog Goes to Bathroom in House Chewing Barking Digging Allergy Escaping from House/Yard Shedding Too Much Dog Grew Too Big Destructive in house (furniture, shoes) New partner allergic or doesn't like dog Biting Dog became ill/high vet bills Kids ignore the dog Pets don't get along Not obedient enough
	Other reason(s)? Please describe. Use as much space as you need.
If you could not keep the dog for any of the above reasons, what would you do with the dog?	Use as much space as you need.
Miscellaneous
Is there anything else you'd like to tell us about yourself?	Use as much space as you need.
How did you hear about Pacific Coast Dog Rescue?	Use as much space as you need.