Adoption Application

Polar Pug Rescue & Friends Adoption Application
Date

MonthDayYear
- Full Name*
  
  First NameLast Name
- E-mail*
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Phone Number*
  
  Area CodePhone Number
- Cell Phone*
  
  Area CodePhone Number
- How many people in the household? Please list all children and ages.*
- Type of housing*
- Do you:*
- If you rent, does your landlord allow pets?
- Do you have a fenced yard?*
- Do you have other dogs?
- List the breed and ages of current dogs in your house.
- Are the other dogs in your household spayed or neutered?*
- If not, explain why.
- Do all family members favor a dog coming into your household?
- If 'No' to the above question, please explain why.
- Do you have any other pets in the home?*
- Please list species, breed and age of other pets:
- Have you ever turn an animal into a shelter? If so, explain why:
- Why do you want to adopt a dog?
- Where will your dog spend most of its time?*
- How many hours will the dog be left alone each day?*
- Are you aware that small dogs are indoor dogs and will you be able to accommodate your dog in this manner?*
- If no to the above question, please explain:
- Would you consider adopting a dog with health issues?
- Are you financially able to provide any needed medical care for your dog?
- What arrangements will you make for your dog if you must travel?
- Do you already have a veterinarian?
- If you have a current veterinarian, please provide a name and phone number. If you don't have a current veterinarian, please provide a name and phone number of someone we can call (not a relative):
- if you have any additional information or comments that you would like to add, please do so:
- Should be Empty:

Polar Pug Rescue & Friends Adoption Application