Papillon Club of America Rescue

Online Adoption Application

Attention: If you have already filled out an adoption application within the past 12 months, you don't need to fill out another one. If you want to add something to it or note a new dog you're interested in, contact us and click on "Append my application".

Name*

Address*

City

State Zip

Phone (H)*

Email*

Please re-enter your email address for verification*

What is the name of the dog(s) you are interested in adopting?

Employment

Company Name

Company Phone

Full Time or Part Time

Are you a student? Yes or No ; If yes, age? Year in school?
(PCA Rescue cannot adopt animals to individuals under 18 )

Housing

What type of dwelling are you in?

House Townhouse/Duplex Apartment
Farm Mobile Home

Do you yourself own this dwelling?

Yes or No

Do you have a fenced yard?

Yes or No ; If yes, How high?
What type of fence?

If you rent, give Landlord's name Phone

Do you have your Landlord's permission to adopt a pet? Yes or No

How many people live in your unit?

Adults Children
Ages of children

If you have roommates, have they agreed to have this pet in their home?

Yes or No

If you are a student or a mobile family, have you thought about the welfare of this animal/pet with your next move, the holidays, etc.? Lifestyle changes for you ALSO affect your pet!

Do you have grandchildren who visit often?

Yes or No

Does anyone in your housing unit have asthma or allergies to animals?

Yes or No

Pets

Do you have any experience caring for a toy or rescue dog?

Yes or No If yes, explain:

Do you have any pets now or have you previously owned any pets?

Yes or No If yes, list type, breed, sex, age, length of time owned, cause and year of death (if applicable) for most recent pets

What happened to previous pets?

Are/were pets spayed or neutered?

Yes or No If no, please explain why

Do any of your current pets have any health or temperament issues?

Are/were pets regularly examined by a veterinarian?

Yes or No If no, please explain why

Name of veterinarian (include phone #)*

Name of person whom the vet records are under*

Where will the dog spend the night?

Where will the dog spend the day?

Responsibilities

Are you prepared to take on the responsibility of caring for this dog for its lifetime, an average of 12-18 years?	Yes or No
Are you willing to have this dog spayed or neutered if it is not already?	Yes or No
Are you willing to spend the time, patience and money to properly train your dog?	Yes or No
Are you prepared to take your pet for a complete vet exam within 10 days of adoption and to continue to provide regular veterinary care for the lifetime of the animal?	Yes or No
This is a long-haired dog, are you willing to spend the grooming time required to maintain the coat?	Yes or No

Are there any dog behaviors that you cannot tolerate and would cause you to return the dog?

Yes or No If yes, please explain

How long will the pet be left alone each day?

When the pet is alone how will you ensure it's safety?

What health problems are you willing to accept?

How important is the pet being housebroken?

Papillons

How long have you been looking for a Papillon?

What sex do you prefer?

Female or Male

What age do you prefer?

Why do you want to own a Papillon?

How far are you willing to travel for a Papillon?

Have you applied to other Papillon Rescue organization(s)?

Yes or No

If yes list organization name(s).

If yes have you had a home visit done?

Yes or No

References

Please list below names, addresses and phone numbers of two local references. These references cannot be family members or roommates. Suggested references are friend, neighbor, supervisor at work, colleague. If you listed a veterinarian on the first page, we will use them as a third reference. We will call these references as part of the adoption process.

Required information is name, address, phone, relation to you.

If you and your pet will live with a roommate or your parents or other relatives for any part of the year, please provide their information as an additional reference below.

Required information is name, address, phone, relation to you.

How did you hear about PCA Rescue?

By checking here, I certify I am giving permission for my personal information to be shared with others within the PCA Rsscue organization

By checking here, I certify that the above information is true. I give a PCA Rescue representative permission to contact my veterinarian, these references, make follow-up calls, and make a home visit.

I would like a copy of my application sent to my email address above.

(please hit only once)