General Information:

*Name:

*Email Address:

*Referred By:

*Home Address:

*City:

*State: Select AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY       Zip:     

*Home Phone:

Cell Phone:

*Age:

*Marital Status:

*Occupation:

Employer:

Work Address:

City:

State: Select AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY       Zip:      Work Phone:

Spouse/Partner Occupation:

Who You're Looking For:

*Name of dog or type of dog you're interested in:

*If you're not sure, what age of dog would you like to adopt? (please select as many as apply)

Puppy Young Adult Senior No Preference

*Male or female?

Male Female No Preference

*What are you looking for in a dog?

*Why are these characteristics important to you?

*Why are you adopting a dog at this time?

*What do you most like about dogs?

*What do you like least about having a dog?

*Who will be the primary caregiver of the dog?

*Why are you considering a rescue dog?

*Are you willing to accept a dog with behavior problems who requires special training? Click here to learn what this means.

Yes No Not Sure

*Are you willing to accept a dog with special needs? Click here to learn what this means.

Yes No Not Sure

*Are you willing to accept a dog with a history of neglect/abuse who needs extra love and attention? Click here to learn what this means.

Yes No Not Sure

About Your Home:

*Type of Residence:

Select House Apartment Townhouse Condominium Mobile Home

*How long have you lived here?

*Do you Rent or Own?

Select Rent Own home Other

*Do you plan to move/relocate within the next year?

If you rent/lease, the following information is required so we can verify that you are allowed pets.

If you rent, are you allowed pets?

Yes No

Does your rental agreement specify a size restriction?

Yes No

Landlord's Name:

Landlord's Phone:

Landlord's Address:

ABOUT YOUR HOUSEHOLD:

Do you have children under the age of 10 who are frequent visitors (such as grandchildren, neighbors, etc.)?

Yes No

If yes, please explain:

Is anyone in your home allergic to dogs?

Yes No

*Do you have a backyard or deck?

Backyard Deck Both Neither

*If yes, is it enclosed?

Select Yes No

If you have a pool, is it fenced?

SELECT Yes No Not Applicable

If you have a dog run, is it secure?

SELECT Yes No Not Applicable

If your yard is fenced, please describe the fence:

*How will your dog relieve/exercise himself?

*What is your household activity level?

SELECT Quiet Active Very active

Please explain

*Do all adults work full time?

Yes No

*How many hours a day will the dog be alone?

Select 3 or less 3-6 6-8 more than 8

*Do you travel often?

Yes No

*Who will care for your pet when you travel?

*Approximately how many hours a day will your new pet be alone?

*Where will your pet be kept when he/she is alone?

*Where will your pet spend the day?

*How much time will you have to spend with your pet?

*Where will your pet sleep at night?

*Who will walk your new dog? And how often?

*Are you prepared to pay someone up to $40, or more, every 4 weeks to groom your pet? Or are you prepared to purchase the necessary equipment and devote the time to learn to groom your pet yourself?

I am willing to pay for grooming I can purchase supplies to groom them myself I am not sure how I will handle the grooming

*Are you willing to spend approximately one hour each week brushing and combing out your pet? This additional maintenance is required whether the dog is being professionally groomed or you are grooming your dog yourself. Are you willing to pluck the hair from the inside of the ears monthly to prevent infections and to clean the eyes of accumulated matter daily if necessary? Are you prepared to deal with the cost of both routine veterinarian care (worming, annual shots) and non-routine/emergency veterinary care, especially as the dog gets older?

Yes to all of the above I have concerns with some of the above I had not thought of this additional care

*If you became ill or temporarily disabled, is there someone who can help care for your dog?

History of Pet Ownership:

*Please list any dog(s) you have owned in the past and explain what happened to him/her.

*Have you ever given an animal to another person, rescue, or shelter? If yes, please explain?

References

Please provide names, relationship and phone numbers of 3 people. At least one cannot be a relative.

*Reference 1:

*Reference 2:

*Reference 3:

*Vet's Name:

Vet's Location:

*Vet's Phone:

Vet records are under the name of:

If you have an additional vet(s), please list the additional information:

Please provide any other information that may be helpful for us to know when reviewing your application

*ADOPTION FEES - Shih Tzus & Furbabies requests an adoption fee ranging from $250-$600. Is this acceptable to you?

SELECT Yes No

Click here to read more about adoption fees.

I certify that the above information is true and accurate to the best of my knowledge, and I understand that completion of this form in no way guarantees my ability to adopt a dog. I further understand that completion of this form is only the firt step in the adoption process and that, should I wish to further this process, and in-home screening will follow.

*Signature of Applicant

*Date of Application

Thank you for taking the time to complete this questionnaire. Your answers will permit us to more effectively match available dogs' needs with your lifestyle and requirements.

Our E-mail address:info@shihtzusandfurbabies.com