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Prospective Intake Questionnaire

This questionnaire is for people who are considering surrendering their dog for adoption. 

Intake priorities are given to senior citizens or chronically/terminally ill people who can no longer care for their dog as well as for dogs whose guardian has passed away. We focus on taking in dogs from Monterey, Santa Cruz, and San Benito Counties, but from time to time we can make exceptions. 

In order for us to take in your dog, your dog must be excellent with people including strangers they have just met. Your dog must also get along well with other dogs with no signs of aggression. If your dog gets along well with children and/or cats, that is a bonus. Before intake, your dog needs to pass an evaluation by a POMDR representative. 

We are able to take in dogs with medical issues from time to time, but space is limited for dogs with major medical issues. This will be evaluated on a case by case basis. 

To get started please answer the following questions, and please submit one form per dog you need help with.

Your Information

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First Name
Last Name
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Please enter the same email address again
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
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Dog's Information

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If your dog is a mix, list the one or two most prominent breeds

If you can, please supply one or two photos of your dog



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Check all that apply
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For example: ignores, politely sniffs, gets excited, barks
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For example: calm, needs a lot of exercise, doesn't have a stop button, settles at home nicely
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For example: needs to be crated, vocal, calm

Additional Information

A donation is not a requirement, but it can make a difference in whether or not we can take in your dog, and it does help us continue our work and cover your dog's expenses.