Pacific Pug Rescue Adoption Application

Pacific Pug Rescue Adoption Application
Thank you for your interest in adopting a rescue dog! Please note we do not accept applications for a waitlist. You can only apply for a dog that is listed on our website as available for adoption.

To help ensure the best possible placement for our rescued dogs, and in order to determine that the proposed adoption is in the best interest of both the dog, you, and your family, please answer the following as thoroughly as possible. Only completed applications will be reviewed.
All correspondence regarding your application will be done by email. If your email filter is set to exclusive you will need to check your junk and spam folders frequently so you do not miss updates on the status of your application.
Which dog are you applying for?*
Full Name*

First NameMiddle NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
Spouse/Partner (Co-Applicant) Name

First NameMiddle NameLast Name
Co-Applicant Phone Number

Area CodePhone Number
Co-Applicant E-mail
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you resided at this address?*
Name and ages of all human members of your household (including yourself)*
Address Information

How long have you been at this address?

Names and ages of all members of your household (including yourself):

Rent or Own?
Employment History

Employer

What are your hours and okay to contact you there?

How Long EmployedWork Phone

Postal / Zip Code
Employer of Spouse/Partner

Spouse/Partner Employer

What are your hours and okay to contact you there?

Work PhoneWork Phone

Postal / Zip Code
Do You Rent or Own?*

RentOwn
Landlord's Name

First NameLast Name
Landlord's Phone

Area CodePhone Number
Landlord's E-mail
Pacific Pug Rescue will reach out to your landlord to verify your ability to have a dog in the home.
Pet History
Have you owned a dog before?*

YesNo
If so what breed(s)?
List all pets currently residing in your home and their ages:
Please list your regular Veterinarian/Vet Clinic
Veterinarian Phone

Area CodePhone Number
Pacific Pug Rescue will reach out to your vet clinic to verify your pets are up-to-date on routine care.
Are all pets up-to-date on vaccines?

YesNo
Are all pets spayed or neutered?

YesNo
If not spayed or neutered, why not?
Do any household members suffer from pet allergies?

YesNo
Do any of your pets have any physical problems?

YesNo
Do your pets get along with other dogs?

YesNo
Will the dog have any exposure to children?

YesNo
Why do you want to adopt a dog?
What characteristics are you looking for in a dog?*
What is your preference regarding the following?
Sex

MaleFemaleNo Preference
Age

Young (1-4 yrs)Adult (5-8 yrs)Senior (8+ yrs)No Preference
Will you consider a dog other than your stated preference?

YesNo
Are you interested in a particular Pug?
Are you willing to house train a dog?

YesNo
Are you willing to house train?

YesNo
Can you deal with a dog that may bark?

YesNo
Can you deal with a dog that may bark?

YesNo
Where will you keep the dog during the day?
Where will you keep the dog at night?
Where will you keep the dog if you are away from home overnight?
Do you have a fenced yard?*

YesNo
What type of fencing and height?
If you do not have a fenced yard, how will you exercise the dog?
How will you provide for their need to eliminate?
What is the maximum number of hours the dog will be left alone during a 24 hour period?
Where will the dog spend this time?
How would you deal with a dog that is destructive when left alone?
Have you ever surrendered to an animal shelter or sold any of your pets?*

YesNo
If yes, please explain the circumstances:
What circumstances do you feel justify giving up a pet?
Are you able to spend at least $1,000.00 per year for food and routine vet care for your pet?*

YesNo
Has anyone in your immediate family/household ever been convicted of a charge related to cruelty to animals or child abuse?*

YesNo
What will you do with your dog if you move?
What things can you and your home environment provide for a dog that has possibly experienced neglect or abandonment?
References

Please provide the names, email addresses, and phone numbers of TWO NON-RELATED individuals who can serve as references:
Reference #1*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Reference #2*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Please double check email addresses and phone numbers for accuracy. Pacific Pug Rescue will reach out to your references by email.
Thank you for taking your time to complete this application. By entering your full name below you attest to the truthfulness of your answers. Falsification of any of the above information will be grounds to disallow your adoption of a rescued dog.
If there are two responsible adults in household, both must sign as an applicant.
Applicant Signature*

First NameLast Name
Applicant Signature

First NameLast Name
"Signed"

MonthDayYearHourMinutesAM/PM Option
Application Donation*

prevnext( X )
USDNon-Refundable Application Donation
PPR Approval Status

ApprovedDeniedMore Information NeededIn ProgressAdopterDuplicate ApplicationNo Response
Application Notes (Internal PPR only)
Should be Empty:

Pacific Pug Rescue Adoption Application

Pet History

What is your preference regarding the following?

References