Prior Adopter Mini-Application
To help ensure the best possible placement for our rescued dogs, and in order to determine that the proposed adoption is in the best interest of both the dog, you and your family, please complete the following. Please be as thorough as possible. Only completed applications are eligible for review.
Full Name
First Name
Middle Name
Last Name
Phone Number
-
Area Code
Phone Number
E-mail
Spouse/Partner
First Name
Middle Name
Last Name
Co-Applicant Phone Number
-
Area Code
Phone Number
Co-Applicant E-mail
Current Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long at this address?
Names and ages of all members of your household (including yourself):
Rent or Own?
If you rent, can you supply written permission to have a dog from your landlord?
If you rent, can you supply written permission to have a dog from your landlord?
Rent or Own
*
Own
Rent
If you rent, please provide:
Landlord's Name
First Name
Last Name
Landlord's Phone
-
Area Code
Phone Number
Landlord's E-mail
Pet History
Please list your regular Veterinarian/Vet Clinic
Veterinarian Phone
-
Area Code
Phone Number
List all pets currently residing in your home and their ages.
Original name of Pug you adopted and year adopted
If not spayed or neutered, why not?
What is your preference regarding the following?
Sex
Male
Female
No Preference
Color
Fawn
Black
Brindle
No Preference
Age
Puppy
Adult
Senior
No Preference
Are you interested in a particular Pug?
Thank you for taking your time to complete this application. By entering your full name below you attest to the truthfulness of your answers. Falsification of any of the above information will be grounds to disallow your adoption of a rescued pug.
If there are two responsible adults in household, both must sign as an applicant.
Applicant Signature
First Name
Last Name
Applicant Signature
First Name
Last Name
"Signed"
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Month
-
Day
Year
Date Picker Icon
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Hour
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Minutes
AM
PM
AM/PM Option
Submit Application
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