Adoption Application – Pomeranian and Small Breed Rescue

Thank you for interest in adopting a rescue dog from Pomeranian and Small Breed Rescue! Don’t forget:

Fill out the form completely – incomplete applications will not be processed
At this time we cannot place dogs in forever homes outside of southwestern Ontario
Applicants MUST contact their veterinary clinic IMMEDIATELY to authorize the release of relevant information about your pets to our Adoption Coordinator.
Personal references cannot be members of your household (i.e. you cannot share an address with either of your personal references) and at least one reference must not be a relative.

Name of Dog:
First Name:
Last Name:
Street Address
City (Within Ontario, Canada ONLY!)
Postal Code
Phone Number
Secondary Number
Email Address
Please list the number of people in your household and their ages and gender:
Do you own or rent your home? OwnRent

If you are not the homeowner, please provide the name and phone number where we can reach the homeowner/landlord:
What style of dwelling is your home?
How long will the dog spend alone on a daily basis?
Where will the dog sleep?
Have you adopted a rescue dog in the past? If so, where did you get the dog from?
Please list and describe all of your current pets (name, breed, age, sex, size, how long you have lived with them)
Please list your previous pets and what happened to them
If you currently have dogs, how would you characterize their temperament toward other dogs?
If you currently have dogs, how would you characterize their temperament toward people?
Do you plan to use a crate for training? Why or why not?
What would you do if your dog bit a person or animal?
What would you do if your dog had separation anxiety?
How would you discipline your dog?
How and how frequently do you plan to exercise your dog?
Are you willing to housetrain a dog? YesNo

How important is the level of barking that the dog displays?
How important is it that the dog likes car rides?
What circumstances would cause you to return the dog to PSBR?
Explain why your experience/environment is the right fit for this specific dog (please read their bio carefully, PSBR will note their particular needs).

Veterinarian Info
NOTE: PSBR may contact your veterinarian during the application process. Please ensure that they are notified of a possible reference call.

Current, or most recent veterinarian and clinic (if applicable)

Veterinarian's Address
Veterinarian's Phone Number
What name are your pets listed under at the clinic? (e.g. your name, your maiden name, spouse's name, etc)

Personal Reference #1 (no family members)
Home Phone Number
Cell/Alternate Number
Best Time to call
Relationship to Applicant

Personal Reference #2 (no family members)

Home Phone Number
Cell/Alternate Number
Best Time to call
Relationship to Applicant

By clicking the Submit button, I, the adopter, attest that to the best of my knowledge the above information is accurate and complete and I understand that falsely providing information can mean that my application will be terminated. Sending this application constitutes an electronic signature.