Prior Adopter Mini Application

Prior Adopter Mini-Application

To ensure the best match for both you and the dog, please answer all questions thoroughly.
What dog are you applying for?*
Applicant Information
Full Name*

First NameMiddle NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
Age*
Spouse/Partner Name (Co-Applicant) Name

First NameMiddle NameLast Name
Co-Applicant Phone Number

Area CodePhone Number
Co-Applicant E-mail
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you resided at this address?*

Rent or Own?
Name and ages of all human members of your household (if you live alone, type "None")*
Rent or Own*

OwnRent
Landlord's Name

First NameLast Name
Landlord's Phone

Area CodePhone Number
Landlord's E-mail
Pacific Pug Rescue will contact your landlord to verify your ability to have a dog in the home.
Pet Ownership History
Please list your regular Veterinarian/Vet Clinic
Veterinarian Phone

Area CodePhone Number
Pacific Pug Rescue will contact your veterinarian/vet clinic to verify all pets are up-to-date on vet care.
List all pets currently residing in your home and their ages.*
Original name of the dog you adopted from PPR and year adopted
Pet Compatibility Preferences
Preferred Sex

MaleFemaleNo Preference
Preferred Age

Young (1-4 yrs)Adult (5-8 yrs)Senior (8+ years)No Preference
Applicant Signature

Thank you for taking your time to complete this application. By typing your full name below you attest to the truthfulness of your answers. Falsification of any of the above information will be grounds to deny your application for adoption.
If there are two responsible adults in household, both must sign as an applicant.
Applicant Signature*

First NameLast Name
Co-Applicant Signature

First NameLast Name
"Signed"

MonthDayYearHourMinutesAM/PM Option
Should be Empty:

Prior Adopter Mini-Application

Applicant Information

Pet Ownership History

Pet Compatibility Preferences

Applicant Signature