TLC Rescue: Dog Adoption Application

Shih Tzu and Precious Paws Adoption Application
Thank you for your interest in adopting a pet from Shih Tzu and Precious Paws Rescue. We ask that you please complete this application as thoroughly as possible, as this information will be used in determining optimal and appropriate suitability between you and our pets.

Please note: we maintain the right to conduct an inspection of the applicant’s home environment as part of the application process. Furthermore, we reserve the right to refuse an applicant based on the information provided, as well as the results of the application process, with or without disclosure of cause. In the event that we discover that any information entered on this application has been knowingly falsified we will reclaim possession of the adopted pet.
PLEASE NOTE: We require a donation for each adopted pet to help defray the costs of veterinary care for our rescued pets. Each pet’s specific adoption donation will be noted in the pet’s profile. Also, at the time of adoption, you will be required to sign a contract committing to the care of the pet, and a rescue volunteer will be responsible for confirming that you have visited a vet and obtained heartworm preventative within the time allotted. Shih Tzu and Precious Paws reserves the right to deny any application based on the information provided as well as the results of the entire application process.

If we cannot get the pet you are interested in, your deposit is refunded. If you are not approved to adopt, your deposit is refunded. IF YOU CHANGE YOUR MIND FOR ANY REASON, YOUR DEPOSIT IS NOT REFUNDED! Normally we do not process applications unless you select a specific pet and make a deposit of $200 as we are all volunteers with limited resources – your deposit tells us you are serious and ready to adopt.
ADDITIONAL NOTES: All fields with an asterisk (*) are required. If something is conditional and/or not applicable, please mark as "NA".

If you have not heard from us in 2-3 days, please contact us at: shihtzumom@centurylink.net
Adopter's Name*
First & Last Name
Address*

Street Address

Street Address Line 2

CityState

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

Area CodePhone Number
Phone Type*

CellHomeWork
Name of the dog you want to adopt*
If a specific pet is not listed above, is there a particular breed you are interested in?
Preferred age of pet*

Puppy )0 - 12 months)Young (1 - 4 years)Adult (5 - 9 years)Senior (10+ years)No preference
Preferred gender*
Preferred energy level of pet*

Low energy, walks slowly on leash, a total couch potatoMedium energy, plays a bit then hangs out with youHigh energy. leash trained daily jogging partner would be excellentNo Preference
Are you willing to adopt a pet with behavioral issues? Elaborate if questions*
Are you willing to adopt a pet with health issues? Elaborate if questions*
Your age*
Your employment status*

Full-timePart-timeRetiredSelf employedWork from homeNon-employed
Name of Employer*
Please describe your typical work schedule.*
What is the best phone number and time to call you to review your application*
Co-Applicant - Name (if applicable)
Co-Applicant - Relationship to primary applicant
Co-Applicant - Mobile Phone
Co-Applicant - Email
Co-Applicant - Age
I/We live in a*

ApartmentCondominiumDuplexMilitary HousingMobile HomeSingle FamilyTownhouse
Do you rent or own this property?*

RentOwn
Landlord Name (required if you rent)*
Landlord Phone # (required if you rent)*
Renters, have you received the approval of your landlord to have a pet? (required if you rent)*

YesNoNot yet, but I willIt's written in our leaseNot Applicable ( I own)
Do you have plans to move from your current residence during the next 6 months?*

YesNo
If yes, please describe *
Age of all adults (18 or older) other than yourself & the co-applicant currently residing in your household *
Age of all children (under 18) residing in your household *
Have all members of your household agreed to adopt and care for the pet*

YesNo
Do you or does anyone in your household have any allergies to any animals*

YesNo
If someone in your household has any allergy to any animals, please describe*
Do you have a yard?*

Yard, fenced with a vertical fenceYard, fenced with invisible fencingYard, no fenceNo yard (apartment/condo/townhome)
If vertical fence, what is your fence height?

2' high3' high4' high5' high6' high
What kind of fence

WoodChain-linkBrickWrought-IronCattle FenceBarbed Wire
Do you currently have any other pets?*

YesNo
If you currently have pets, please list and complete the info below for each pet (Name, Species, Gender, Age)*
Have all of your other pets, both past and present, been spayed or neutered?*

YesNo
Do all of your current pets wear either ID tags and/or are microchipped?*

YesNo
Have you ever given up a pet or had to put a pet to sleep?*

YesNo
If yes, and within the last 5 years, please provide the name of the pet(s) and the circumstances regarding your loss*
How much time, on average, will the pet spend alone during the day*

Less than 1 hour1-4 hours4-8 hoursMore than 8 hours
If you are applying for a dog & the dog would be alone for more than 4 hours, do you have a plan to ensure the dog is cared for*

YesNo
If yes, please describe*
If applying for a dog, how do you plan to exercise the dog? Please include in your response where you will take the dog to get exercise, and how often the dog will be exercised*
If applying for a dog, are you willing to take the dog to obedience class, if necessary?*

YesNo
Describe where the pet will spend his/her time when you are at home.*
Describe where the pet will spend his/her time when you are NOT at home.*
Describe where the pet will spend his/her time at night*
Describe where the pet will spend his/her time when you have company at your home*
Do you have a plan if you travel and are unable to take your pet?*

YesNo
If yes, who will care for the pet and where?*
Do you currently have an established relationship with a veterinarian and/or veterinary practice?*

YesNo
Veterinary Practice info (Name, City, State, Phone Number*
Personal References #1*
Personal References #2*
Personal References #3*
Shih Tzu and Precious Paws adoption contract requires that if should you be unable to keep this pet for any reason, you must return the pet to us. Are you willing to agree to this condition?*

YesNo
By signing this application, I affirm that ALL information is true and complete and that no one in the household where the pet will reside has ever been convicted of animal cruelty or abuse. I agree to give permission for a representative of FOHA to call the references and veterinary practices I have listed. I also understand that a home visit by a FOHA representative is required for every pet application, and furthermore that FOHA reserves the right to deny any adoption application with or without disclosure of cause. I also confirm that I have read or been explained the deposit policy for the pet I am applying for. I understand that if any of the information provided in this application or throughout the adoption process is found to have been falsified, my deposit will not be refunded. Please initial the line below to indicate that you agree.
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*
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?*
Click on the SUBMIT button below. You will be taken back to the Petfinder site.

If you have not heard from us in 2-3 days, please contact us at: shihtzumom@centurylink.net
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Shih Tzu and Precious Paws Adoption Application