Pacific Pug Rescue Adoption Application

Pacific Pug Rescue Adoption Application
Thank you for your interest in adopting a rescue dog!
- Please only apply for dogs currently listed as available on our website; as we do not have the ability to maintain waitlists.
- To ensure the best match for both you and the dog, please answer all questions thoroughly.
Which dog are you applying for?*
If you are approved to adopt, when would you be available to pick up your new pup?

ASAP (within a week)Within 1-2 weeksLonger than 2 weeksOther
I agree to pay a $15.00 non-refundable application processing fee in order for Pacific Pug Rescue to review my adoption application.*

I agree
I understand all correspondence regarding my application will be done via email (adoptions@pacificpugrescue.org) and will check my email filters frequently to make sure any correspondence does not end up in my junk/spam folders*

I agree
Pacific Pug Rescue may contact my landlord, veterinarian, and references (if applicable) as part of the adoption application process.*

I agree
I understand I must travel to the Portland Oregon Metro Area to pick up my new pup if I am approved to adopt*

I agree
Applicant Information
Full Name*

First NameMiddle NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
Age*
You must be 21 y/o or older to adopt
For senior or retired applicants, have you considered the possibility that the dog may outlive you? Please tell us any plans or arrangements you've considered in case of this.
Employment History

Employer Name

What are your hours and okay to contact you there?

How Long EmployedWork Phone

Postal / Zip Code
Co-Applicant (Spouse/Partner) Name

First NameMiddle NameLast Name
Co-Applicant Phone Number

Area CodePhone Number
Co-Applicant E-mail
Co-Applicant's Employer

Co-Applicant's Employer Name

What are your hours and okay to contact you there?

Work PhoneWork Phone

Postal / Zip Code
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you resided at this address?*
Name and ages of all human members of your household (if you live alone, type "None")*
Do You Rent or Own?*

RentOwn
If you rent, Pacific Pug Rescue will reach out to your landlord to verify your ability to have a dog in the home.
Landlord's Name

First NameLast Name
Landlord's Phone

Area CodePhone Number
Landlord's E-mail
Pet Ownership History

Please provide details on any current or previous pet ownership experience
Have you owned a dog before?*

YesNo
If yes, what breed(s)?
Do you currently have other pets in the household?*

YesNo
If yes, list pets currently residing in your home and their ages
Pacific Pug Rescue will reach out to your vet clinic to verify your pets are up-to-date on routine care.
Please list your regular Veterinarian/Vet Clinic
Veterinarian Phone

Area CodePhone Number
Are all pets up-to-date on routine vaccines?

YesNo
Are all dogs or cats spayed or neutered?

YesNoNot Applicable
If not spayed or neutered, please provide reason
Pet Compatibility Preferences
Preferred Sex

MaleFemaleNo Preference
Preferred Age

Young (1-4 yrs)Adult (5-8 yrs)Senior (8+ yrs)No Preference
Are you willing to house train a dog?

YesNo
Can you deal with a dog that may bark?

YesNo
Will the dog have any exposure to children?

YesNo
Where will you keep the dog during the day?*
Where will you keep the dog at night?*
Where will you keep the dog if you are out-of-town?*
Do you have a fenced yard?*

YesNo
What type of fencing and height?
If you do not have a fenced yard, how will you exercise the dog?
What are the maximum number of hours the dog will be left alone in a 24 hour period? What is your typical schedule like weekly?*
Have you ever surrendered or sold any of your pets?*

YesNo
If yes, please explain the circumstances:
Is there any other info you would like to share?
Personal Reference

Please provide the name and email address of a NON-RELATED personal reference. Pacific Pug Rescue may reach out to them so please make sure they are aware and respond in a timely manner if so.
Reference Name*

First NameLast Name
Reference E-mail*
Applicant Signature

Thank you for taking your time to complete this application. By typing your full name below you attest to the truthfulness of your answers. Falsification of any of the above information will be grounds to deny your application for adoption.
If there are two responsible adults in household, both must sign as an applicant/co-applicant.
Applicant Signature*

First NameLast Name
Co-Applicant Signature

First NameLast Name
"Signed"

MonthDayYearHourMinutesAM/PM Option
A $15.00 non-refundable application processing donation is required prior to Pacific Pug Rescue reviewing your application. Please see directions below to pay the application processing donation.
Application Processing Donation Payment Method*

Credit/Debit CardPaypal @pacificpugrescue.orgVenmo @pacificpugrescue
After you submit this contract, you will be redirected to your payment method preference page to make your adoption donation. Please do not close this page before you are redirected
Should be Empty:

Pacific Pug Rescue Adoption Application

Applicant Information

Pet Ownership History

Pet Compatibility Preferences

Personal Reference

Applicant Signature