Adoption Application
We do not ship our companion animals. We do not adopt to homes with small children. There will be a required Adoption Donation fee starting at $600.
Name
*
First Name
Last Name
Driver's License #
*
Age
*
Marital Status
*
Spouse's Name
*
Spouse's Age
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Home or Cell #
*
Please enter a valid phone number.
Format: (000) 000-0000.
How many people live in the home, what are their ages, and their relationships to the applicant?
*
How many children live at home and what are the children's ages?
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Are there any children that visit your home often, if so, please explain?
*
If you currently have no children and are planning on starting a family, how will this affect the future of your companion animal?
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What type of Home?
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Do you rent or lease your home?
*
Yes
No
Property Manager & Management Co name if applicable
Management Phone #
Please enter a valid phone number.
Format: (000) 000-0000.
Does your landlord allow pets?
Yes
No
Don't Know
Landlord's Name
Landlord's Phone #
Please enter a valid phone number.
Format: (000) 000-0000.
Employer & Job Title
*
If retired, past occupation
*
Spouse Occupation
*
Applicant working hours
*
Applicant work phone #
*
Please enter a valid phone number.
Format: (000) 000-0000.
Best time to call
*
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Where did you hear of us?
*
What companion animal(s) are you interested in adopting?
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Have you applied to adopt a dog with other rescue group(s)? If so, please list.
*
Why are you looking to adopt a dog, and why did you choose to adopt rather than buy from a pet store or breeder?
*
What age range companion animal would you consider adopting?
*
enter numerical range
What made you decide to adopt this particular companion animal over the others?
*
Have you had any previous experience with this "breed"(s)?
*
What temperament are you looking for in a companion animal?
*
Will you allow us to visit your home before or after you adopt your companion animal?
*
Yes
No
Who will have primary responsibility for the care of your companion animal?
*
Do you have any health issues that would prevent you from providing your companion animal with a lifetime home?
*
Your newly adopted companion animal's living situation (check all that apply)
*
Will live indoors
Will live indoors & outdoors
Will live in garage/patio/balcony
Will live outdoors only
Will live outdoors only with a dog house/shade
How much time can you dedicate to your companion animal on a daily basis?
*
How many hours a day will your companion animal be alone and why?
*
When home alone, your newly adopted companion animal would stay where? (check all that apply)
*
Loose indoors
Confined to one room
Kept crated indoors
Kept crated outdoors
Outside loose in fenced yard
Outside loose in unfenced area
Tied/Chained outdoors
How will you exercise your companion animal?
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Where will your companion animal sleep?
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Where will your companion animal stay when you are away from home (overnight, vacations, etc)
*
How much money are you willing to spend on your companion animal yearly?
*
Are there any medical conditions you are not willing to treat? If so, please explain.
*
Are you willing to purchase dog insurance for catastrophic coverage?
*
Yes
No
Under what circumstances would you consider finding somewhere else for your companion animal to live?
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What would you do if you could not keep your companion animal?
*
What behaviors would you consider unacceptable?
*
What would you do to correct the above behavior?
*
Would you consider adopting a companion animal who requires additional behavioral or house training?
*
Yes
No
What temperament do you like your companion animal to have?
*
Would you consider adopting an abused companion animal?
*
Yes
No
Would you consider adopting a special needs companion animal?
*
Yes
No
Do you or did you use heartworm preventative on your current & past companion animals? If so, what brand and where was it purchased? If not, please explain.
*
Are/Were your companion animals vaccinations kept up to date? Please explain.
*
Do you currently have any pets?
*
Yes
No
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Please list any companion animals you have now or have had in the past ten years. If not applicable, please enter NA.
If additional space is needed please continue in the comments section (at the end of the application).
Pet # 1
*
Pet # 2
*
Pet # 3
Pet # 4
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Personal References - Please list three personal reference, they can include neighbors, relatives, friends, etc.
Reference # 1
*
Reference # 2
*
Reference # 3
*
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Veterinary References - Please list the veterinarian that you have used in the past (if applicable).
If you have used more than one vet, throughout your pet-owning years, please list additional Vets below as well. If you have never had a pet please list the vet that you plan to use on your newly adopted companion animal.
Vet Info #1
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I agree to return the adopted animal to Shih Tzu Rescue if I can no longer care for it.
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Yes
No
I am financially/physically able to care for the adopted animal. I understand the expenses involved in pet care and I'm able & will meet these requirements.
*
Yes
No
I am stating that the information in the above pages is true, as typed, and that if any information is found to be false Shih Tzu Rescue will reclaim the said animal.
*
Yes
No
I understand that should I adopt from Shih Tzu Rescue, an adoption fee starting at $600 is part of the adoption process. Shih Tzu Rescue is a non-profit organization and this adoption fee helps with the costs of caring for all of the rescued dogs.
*
Yes
No
I have indicated that this is a valid and legal substitution for your written signature on this legal document.
*
Yes
No
Additional comments.
Please note that Shih Tzu Rescue reserves the right to refuse adoption.
Submit
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