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Adoption Questionnaire

Thanks for your interest in adoptiong! 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 get the process started.

Dog's Information

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Adopter's Information

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First Name
Last Name
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(mm/dd/yyyy)
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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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Current and Former Pets

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More About the Home for the Dog

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Adoption Questionnaire Agreement

I confirm that all information supplied on this questionnaire is correct, and acknowledge that adopting a dog from POMDR is at my own risk. On behalf of myself, my heirs, personal representatives and executors, I hereby release, discharge, indemnify and hold harmless POMDR, its board of directors, officers, staff and all other persons and organizations in any way connected with POMDR from any and all claims, causes of action, or demands, of any nature or cause, including costs and attorney's fees incurred by POMDR in connection with the same, based on damages or injuries which may be incurred or sustained by me in any way connected with my adoption a dog from POMDR, including but not limited to animal bites, accidents, or injuries.

I understand that this confirmation and agreement does not guarantee I will be approved to adopt a POMDR dog. Approval is pending an interview, home safety check, and availability of dogs.

Photo Release

I understand that public relations is an important part of POMDR’s ability to raise funds for people like me in need of assistance . On behalf of myself, my heirs, personal representatives, and executors, I allow POMDR to use any photographs taken of me or my pet or submitted by me for use in public relations efforts including print materials, website, and social media. Also, all photographs that I submit to POMDR will remain the property of the photographer. POMDR will have the rights to use these photographs for marketing materials or in any other ways that POMDR sees fit.

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