Luv A Chin Rescue Adoption Application

Full Name (First Last)*

Full Address (Street, Apt #, City, State, Zip Code)*

What type of home do you live in?*

Is this House, Apartment, Condo, Trailer, Other (if other please describe)

Do you own or rent your home?*

If you rent, can you provide leasing documents stating you are allowed to have pets? If own, can you provide HOA documents regarding pets?*

Contact Number*

Is this Mobile, Home, Work

Alternate Number*

Is this Mobile, Home, Work

Email Address*

Is this Home, Work

Which dog or dogs are you applying for*

Why are you interested in adopting at this time*

Have you applied/considered another dog from another rescue or shelter?*

If so, which one and where is it located?

Have you previously adopted from Luv A Chin Rescue?*

If so, what dog did you adopt and when

Do you know any current or former member of Luv A Chin Rescue?*

If so, who and what is your relationship

Age of Applicant?*

If so, who and what is your relationship

Name, Age and Relationship of others in the household to the Applicant*

Occupation of Applicant*

Do you work from home, go to an office, hybrid

Occupation(s) of additional adults in your home*

Do they work from home, go to an office, hybrid

How many hours each day will the dog be alone*

Where will the dog be when you are not home? *

Roam the house, Indoor kennel, Limited to laundry room, bedroom, etc

If you are gone more then 6 hours a day, what are the plans for a mid day potty break?*

Pet Sitter, Neighbor, Dog door, etc

If you travel, where will the dog stay while you are gone?*

Pet Sitter, Neighbor, Boarding facility, Day Care, Family, etc

Where will the dog spend the majority of it's time in your home? If other location, explain*

In the house, in the yard, basement, garage, other

Where will the dog sleep at night?*

In the house, in the yard, basement, garage, other

Do you have an enclosed fenced yard? Please describe the fencing (height, material, etc)*

4 ft chain link, 6 ft wood privacy, vinyl fencing

Does anyone in the household have allergies to dogs? If yes, how will that be addressed*

List all household pets (Names/Age/Breed/Gender/Altered (Spay or Neutered)*

Who will be responsible for the care of the dog?*

What pets have you previously owned? What breed(s)? When?*

Have you ever returned, rehomed, surrendered or given up a pet?*

dog, cat, other

If yes, please explain the circumstances of rehoming, surrendering or giving up the previous pet(s)*

Have you been or currently are a member of any other animal rescue, shelter, club or organization?*

If yes, list the name of the organization(s) and your capacity in the organization*

How long have you been involved with Japanese Chins?*

Are you familiar with the potential health issues of the Japanese Chin breed?*

Are you willing to adopt a dog that is not house trained?*

If needed, are you willing to use potty pads in your home?*

If this is a special needs dog, please specify how you will address any specific needs of the dog*

Is there any other information that you feel would help us more fairly evaluate your application?*

Do you agree to have a representative of Luv A Chin Rescue visit your home by appointment either in person or virtually?*

PERSONAL REFERENCE #1 information: First and Last Name, Address (City, State, Zip Code). Phone Number, Email Address, Relationship to you:*

PERSONAL REFERENCE #2 information: First and Last Name, Address (City, State, Zip Code). Phone Number, Email Address, Relationship to you:*

If Applicable, LANDLORD/PROPERTY MGR contact information: First and Last Name, Address (City, State, Zip Code), Phone Number, Email Address*

VETERINARIAN INFORMATION: Doctor's First and Last Name, Clinic Name, Address (City, State, Zip Code), Phone Number, Email Address*

🐾 Adoption Application Agreement and Terms. Please read the following statements carefully before signing this application. By submitting this form, you are affirming your understanding and acceptance of these terms. 1. Verification of Information: I/We hereby certify that all information provided in this adoption application is true, accurate, and complete to the best of my/our knowledge. I/We understand that providing false or misleading information may result in the immediate denial of this application or the revocation of any future adoption. 2. Adoption Fee and Financial Responsibility: I/We confirm that I/we are able and willing to pay the non-refundable adoption fee established by Luv A Chin Rescue for the dog(s) if this application is approved and I/we proceed with the adoption. I/We understand this fee helps cover the costs of veterinary care, food, and housing for the animals in the rescue's care. 3. Application Review and Consideration: I/We understand that this application is not an automatic approval and is merely the first step in the adoption process. This application will be thoroughly reviewed and considered by Luv A Chin Rescue based on the best interest of the dog(s). Luv A Chin Rescue reserves the right to approve, deny, or request additional information from any applicant for any reason. 4. Commitment to Care: I/We understand that adopting a dog is a serious, long-term commitment. I/We agree to provide the adopted dog(s) with a safe, loving, and permanent home, including necessary veterinary care, proper nutrition, adequate shelter, and consistent training and socialization. By Electronically Signing Below, I/We are agreeing to the Adoption Application Agreement and Terms *

Type your Full Name and Date in the box above

Signature*