TLC Rescue: Dog Adoption Application

Vintage Pug Adoption Application
Adoption Fee $200 (covers full vetting)

"Seniors for Seniors" Fee $100 (for adopters over 65

Fees are payable via check, PayPal or Venmo and must be paid in advance of pick up.
Sumitting this application does not mean you are commiting to a dog, nor does it guarantee you will get that dog. It is simply a tool we use to help both you and us identify a good potential match for your family and lifestyle.

A successful adoption depends on selecting the right dog for your household and a good understanding of the dog's needs and care requirements. Please help us with this process by answering the following questions fully & completely. THANK YOU!
Name of the dog you want to adopt*
Adopter's Name*
First & Last Name
Co-Adopter's Name
First & Last Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Adopter's E-mail*
Co-Adopter's E-mail*
Phone Number*

Area CodePhone Number
Phone Type*

CellHomeWork
Names and ages of all permanent residents of your home (adults/children)*
Do you currently have any pets?*

YesNo
If you currently have pets, please list them below.
Are your current pets altered?

YesNoWill be within the next 30 days, appointment has been scheduled. (We will call your vet to verify this.)
If your current pets are not altered, please explain why below.
Vet reference (please call your vet and give permission to release information to us)*
Vet name, address & phone number
Two Personal References*
Are you planning to move in the near future?*

YesNo
If moving soon, to what city/state?
When will you be ready to adopt this dog?*

TodayThis weekendWithin a weekWithin a monthNot ready yet, just researching
Are you in contact with any other rescues or shelters about a specific dog?*

Yes, application is pendingYes, just an email inquiry, no app yetNo, but I am looking at several dogs onlineNo, I am only interested in this particular dog
Are you going to meet another dog?*

YesNo
Is anyone in your home allergic to dogs?*

YesNo
Are you familiar with dog regulations in your area?*

YesNo
If you answered no to the question above, please contact your town/county/condo assoc and ask them what the regulations are.
I/We live in a*

Single Family HomeDuplex/TwinCondo/TownhomeTrailerApartment
Do you rent or own this property?*

RentOwn
Renters, have you contacted your landlord to find out if there's any restrictions on the kind or size of dog you can have?

YesNoNot yet, but I willIt's written in our lease
If you rent, you must show us a written letter from your landlord or a copy of the section of your lease stating that you are allowed to have dogs and showing any limitations.

If you live in a condo or townhome, you must show us written proof that you are allowed to have a dog there and show any restrictions.
Do you have a yard?*

Yard, fenced with a vertical fenceYard, fenced with invisible fencingYard, no fenceNo yard (apartment/condo/townhome)
Do you work outside the home?*

YesNoOne applicant is home/works from homeWe work different shifts
If you both work outside the home, how many hours per day are you away?
How many hours per day will this dog be alone? Please explain.*
Have you discussed this adoption with all members of your household?*

YesNoYes, adults have discussed. Kids don't know yet.
All adult residents must be aware of this application process and wants to have a dog added to the family. Please do not submit this application if you are "trying to talk someone into" adopting this dog or think "once they meet the dog, they will want one" or "I'm getting this dog as a surprise birthday present for them." In those scenarios, you are welcome to email us to discuss the dog, but we would like all adults in the home to be involved in that email discussion.
Based on the description in the dog's bio, do you feel pretty confident that you will be likely to adopt this dog upon meeting it?*

YesNoNot sure
Upon meeting the dog, what would give you cause to not want to adopt it? Please explain.*
What activity/energy level do you prefer?*

Wild and crazy is coolLeash trained daily jogging partner would be excellentMedium energy, plays a bit then hangs out with youLow energy, walks slowly on leash, a total couch potatoOther
Please check all that apply. I want to adopt this dog...*

As a family petTo breed with my dogTo train/use for huntingTo train/use for agilityTo train/use as a therapy dogTo train/use as an assistance dog for the disabledTo use as a guard dogFor a jogging/hiking partnerTo interact with lots of friends/familyAs a gift for a friend, partner, or family memberAs a companion for my dog(s)As a companion for my cat(s)As a companion for my child/children
Please check all that apply. My adopted dog will...

Be kept outside most of the timeBe kept indoors most of the timeBe left outside during the work day while we are awayBe kept inside while we are awayBe crated when we are not homeHave free reign of the house when we are not homeBe taken to formal obedience classesBe trained by me/usTake frequent car rides with usBe kept on a lead line/cable in the yardBe mostly interacting with adultsBe interacting frequently with children under 8Be interacting frequently with older childrenMust be housebroken prior to adoptionWill be housetrained by usWill be walked more than one mile per day every dayWill be walked occasionallyBe attending formal group obedience classes with usBe trained by us without the advice of a trainerHave private sessions with a trainer as neededBe attending agility classesBe taking frequent car rides/trips with usBe boarded when we go on vacationStay with family when we go on vacationBe given away to someone else if we feel it's not a good match for usBe turned in to a shelter if we can't keep itBe going camping with usBe going on boat trips with usBe outside with a dog house in a fenced areaBe outside chained/tethered to a dog houseBe free roaming on the farm (unfenced)Other
Please take time to think, be honest with yourself and us when answering this question. What are you absolutely NOT willing to deal with at the time of adoption or at any time during the life of the dog?*

HousebreakingChewingJumpingPulling on leash during walksCounter surfingObedience trainingFear of menFear of womenFear of childrenMouthiness (may sometimes snag your hand or arm instead of the toy in play and will need redirection/training)GrowlingBarkingRough play with my dogHigh activity levelFood/toy aggression/not willing to share with other dogsFood/toy aggression with peopleWhining/cryingCounter surfingBlindnessLimited SightDeafnessSeparation AnxietyDiabetesSpecial DietLong Term MedicationIncontinence / Leaking UrineTaking classes with the dogGets stressed/carsick when riding in vehicleDoesn't know how to climb stairsCan't climb stairs due to age/arthritis/health issuesHeart conditionSkin allergiesFood allergiesTrimming nailsYeast on coat or in earsEar mitesFleasTicksHeartworm preventativeAnnual heartworm/lyme combo testingI will do whatever it takes to help this dog adjust and work with a trainer to help resolve any training needs.Other
What would cause you to return a dog?*
What would you do if you discovered after adoption (at any time during the life of the dog) if your vet diagnosed an expensive health condition?*
Do you have any additional comments, questions or concerns? Anything else you would like us to know to help match you up to a dog?*
I understand that completing this application does not guarantee I will be allowed to adopt a dog, and that the application is a tool to help Vintage Pug Senior Sanctuary determine if this dog and my family are a good fit for each other. I acknowledge that all information provided on this form is true and correct. I understand that any misrepresentations may result in my not being approved and/or removal of the adopted dog from my possession. I also certify that I have never been convicted of animal cruelty or neglect.

I agree to allow a representative from Vintage Pug Senior Sanctuary to contact my vet for a reference and also agree to allowing a home visit prior to adopting this dog.

If I am approved to adopt a dog, I agree to pay a non-refundable adoption fee and hand sign an adoption contract at the time of adoption.

I understand that all dogs adopted from Vintage Pug Senior Sanctuary will be spayed/neutered, heartworm tested, fecal tested, and vaccinated prior to adoption.
Please read the above, check this box, sign, and click Submit.*

I/We have read and understand all of the above.
Applicant's Signature*
Co-Applicant's Signature
Signature date*
After you submit this form, it will take you back to the Vintage Pug home page. Feel free to email us with any questions:

vintagepugseniorsanctuary@gmail.com

Renters: Please send a copy of the pet section of your lease or a landlord pet permission letter to the email address above.

Vintage Pug Senior Sanctuary reserves the right to reject any application based on information obtained during this screening process. Please understand that our primary goal is the health, happiness, and safety of our rescued dogs.
Should be Empty:

Vintage Pug Adoption Application