Patricia J. Bauer Center:
615 Forest Avenue
Pacific Grove, CA 93950
11am - 4pm, Monday - Saturday
or by appointment

Adoptable dogs available by appointment only.

Mailing Address:
P.O. Box 51554
Pacific Grove, CA 93950
Phone: (831) 718-9122
Email Us

Peace of Mind Dog Rescue
is a non-profit 501(c)(3) Corp.
TAX ID NO. 27-1154816

POMDR Adoption Questionnaire

Peace of Mind Dog Rescue is committed to making the best match for our adoptable dogs and the best match for the families interested in bringing a new dog into their home. Please provide the following information so that we can make the best matches. Thanks!

Dog’s Information

Dog’s Name:

Where did you hear about this dog? If other:

Adopter’s Information

First Name:

Last Name:

Email Address:

Email Address Again:

Street Address: City: State: Zip:

Home Phone: Work Phone:

Cell Phone:

How long at this address?

If renting, does your housing lease allow pets?  

Name and phone number of lessor:

How many adults at this address?   Adults' ages:

How many children?   Children's ages:

Is anyone in your household allergic to animals?

If so, what type(s)?

Current and Former Pets

Description, breed and age of all animals that reside with you now:

How do your current pets generally do when meeting a new dog? Do you anticipate any issues with them getting along with a newly adopted dog?

If your animals are not spayed or neutered, please explain (it is POMDR policy that all adopters have their cats and dogs altered):

Do your animals have current vaccinations?

Other animals you've had

When was the last time and for how long?

If you no longer have the dog/cat/other, what happened to them?

Have you ever surrendered one of your pets to a shelter?  

If yes, explain the circumstances:

More About the Home for the Dog

Are you getting this dog as a gift for someone?

If yes, for whom?

If you have children, have they ever had a dog/cat/other in the household before?

Where will the dog live and sleep?

The dog will be

Describe circumstances when and how long the dog would be outdoors:

Would the dog have full access to your home?

If not, explain:

What form of exercise would a dog get in your care? (Number of walks, length, on leash, off leash, backyard play, etc.):

Who will be the primary caretaker of the dog?

Who will care for the dog when you are away from home?

If your dog gets sick, can you afford vet bills?  

How many hours per day would the dog be left alone?

How will your new dog spend a typical day?

Do you have a securely fenced yard?

If yes, please describe the fence type and height:

Do you have a dog door? (Not required)

Are there any smokers at your home?

If yes, do they smoke indoors?

If you are adopting a senior dog, have you ever cared for a senior dog before? N/A

Are you aware of the special care and expense senior dogs may require?

Please let us know particularly what interested you in this dog and provide any other comments about yourself and the home you are offering: