THE IMPERIAL JEMNETICS™ SHIH TZU PUPPY APPLICATION FORM

THE IMPERIAL JEMNETICS™ SHIH TZU

The Home of Imperial Shih-Tzus in the Philippines
MABUHAY!

Welcome to Jemnetics™

At Jemnetics™, we believe every puppy deserves a loving, responsible, and lifelong family. Completing this application allows us to get to know you better so we can determine if one of our puppies is the right fit for your home.

Please note:
- Submission of this application does not guarantee puppy reservation or purchase.
- We reserve the right to decline any application if we believe the placement is not in the puppy's best interest.
- Approved applicants may be placed on our priority waiting list.
GET STARTED
Name

First NameLast Name
Age
Gender
Occupation
Company / Business
Home Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Facebook URL
e.g. https://www.facebook.com/jem.mendoza.330/
Facebook Page / Website URL
e.g. https://www.facebook.com/imperialjemnetics/
Preferred Method of Contact

How did you hear about The Imperial Jemnetics™ Shih Tzu?

Other
If referred, who may we thank?

YOUR IDEAL PUPPY
Preferred Gender
Preferred Color
Preferred Size
Are you willing to wait for the right puppy if your preferences are unavailable?
Purpose of Purchase

Other
All puppies (except purchased with Full Breeding Rights) will be spayed/neutered.

YOUR HOUSEHOLD
Who lives in your home?
Number of Adults
Number of Children
Age of Youngest Children
Does anyone in your household have pet allergies?
Do all members of your household agree to getting a puppy?

YOUR HOME
Do you:
If renting, are pets allowed?
Type of residence

Other
Will your puppy primarily live:

YOUR EXPERIENCE WITH PETS
Have you owned a dog before?
Do you have a current pets?
If yes, what are their breed(s), gender(s), age(s), and their total number.
Have you owned a Shih Tzu before?
Have you ever surrendered or rehomed a pet?
If yes, please explain

RESPONSIBLE OWNERSHIP
How would you describe your daily lifestyle?
What qualities are most important to you in a puppy?
Why do you believe a Jemnetics™ puppy is the right fit for your family?
What will happen to your puppy if you relocate, experience financial hardship, or have significant life changes?

BREEDER POLICIES
By submitting this application, I understand that:
- Submission of this application does not guarantee approval.
- Puppies are matched according to temperament, health, and suitability—not solely by appearance.
- Prices vary depending on pedigree, quality, color, and breeding rights.
- Reservation fees/deposits are subject to the terms stated in the Puppy Reservation Agreement.
- The breeder reserves the right to refuse any sale that is not in the puppy's best interest.
- I understand that estimated adult size, coat color, bite, and other developing characteristics cannot be guaranteed.
- I agree to provide a safe, loving, and permanent home for my puppy.

DATA PRIVACY CONSENT

Republic Act No. 10173 (Data Privacy Act of 2012)
By submitting this Puppy Application, I voluntarily provide my personal information to The Imperial Jemnetics™ Shih Tzu.

I understand and consent that my information may be collected, processed, stored, and used solely for the following purposes:

• Evaluating my puppy application;
• Contacting me regarding available puppies, reservations, or waitlist status;
• Preparing contracts, invoices, and ownership records;
• Providing after-sales support and health updates;
• Complying with applicable Philippine laws and regulations.

My personal information will not be sold, rented, or disclosed to third parties except when required by law or when necessary to fulfill the purposes stated above.

I understand that I have the right to access, correct, withdraw, or request deletion of my personal information, subject to applicable legal and contractual obligations.

By agreeing below, I confirm that the information I have provided is accurate and complete and that I consent to the collection and processing of my personal information in accordance with the Data Privacy Act of 2012 (Republic Act No. 10173).
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