Puppy Adoption Consideration Form
AKC Shih Tzu
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you or have you ever owned a Shih Tzu?
Phone Number (Mobile)
*
-
Area Code
Phone Number
E-mail
*
example@example.com
Do you own or rent?
*
Own
Rent
Do you have a fenced in yard?
*
Yes
No
Are there any children in the home? (If yes, please list ages)
*
Yes
No
Will you crate your pet?
*
Yes
No
How many hours of the day will the pet be alone at home?
*
If you have to leave town, emergent or planned, where will your pet stay?
*
This is a fill in the
blanks
field. Please add appropriate
blank
fields and text.
How will you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, or unruly leash behavior in your pet?
*
Do you own any other pets? If yes, how many? (Cat or dog)
*
What is the breed of your pet?
*
What is your pets disposition and behavior toward other dogs?
*
Is your pet male or female?
*
Yes
No
Is your pet spayed / neutered?
*
Yes
No
Please provide three references including name and phone number.
*
Is your pet used to other pets?
Yes
No
Other
Do you or anyone in your home smoke?
Yes
No
If yes, do you smoke in your home or car around your pet?
Yes
No
Sometimes
Do you have a regular veterinarian?
*
Yes
No
Veterinarian’s name
*
Vet Clinic's Telephone
*
-
Area Code
Phone Number
Have you ever been convicted of an animal related crime, such as animal cruelty, animal theft, and or animal abandonment? (If yes please explain in detail)
*
*
By clicking the submit button, I agree to Smoochie Poochie Shih Tzus adoption process, will undergo a interview at the discretion of Charlotte Hammack, Founder & Owner of Smoochie Poochie Shih Tzus. By clicking the submit button, I understand Charlotte Hammack will check my references including veterinary and personal. By clicking the submit button, I understand there is a $500 Non-Refundable Deposit Required to hold the puppy until 10 weeks of age. By clicking the submit button, I understand that Charlotte Hammack will provide any and all of the pet's records and treatments. By clicking the submit button I understand that if I no longer want my pet, or am no longer able to care for my pet at any time, Charlotte Hammack will take the pet back and will take care of transportation of pet back to Smoochie Poochie Shih Tzus, where it will be examined by a vet & re-homed at the discretion of Charlotte Hammack. By clicking the submit button I fully understand that all adoptions are at the complete discretion of Charlotte Hammack, and submitting an application does not guarantee puppy placement. By clicking the submit button, I verify all of the above information is true and accurate.
Date
-
Month
-
Day
Year
Date
Signature of Potential Pet Parent
*
Submit
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