NAME:

ADDRESS:

PHONE (HOME, WORK, CELL, PAGER):

EMAIL:

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TYPE OF DWELLING YOU RESIDE IN (HOUSE, CONDO, MOBILE HOME, ETC.)

DO YOU RENT OR OWN?

IF RENTING, ARE YOU ALLOWED TO HAVE PETS (IF SO, HOW MANY)?

NAME OF VET YOU WILL BE USING:

VET ADDRESS AND PHONE NUMBER:

NAME OF GROOMER YOU WILL BE USING:

GROOMER ADDRESS AND PHONE NUMBER:

ARE ALL FAMILY MEMBERS IN AGREEMENT ABOUT GETTING A NEW PET?

DO YOU HAVE ANY PETS AT THIS TIME?

IF SO, ARE THEY ALL SPAYED OR NEUTERED?

PLEASE LIST PETS (NAME, AGE, BREED, TYPE):

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IF YOU OWN A CAT, IS IT DECLAWED?

WHERE DO PETS STAY WHEN YOU ARE NOT HOME?

DO YOU HAVE A FENCED BACKYARD (IF SO, WHAT KIND OF FENCE, HEIGHT,ETC.)?

ARE YOU OR ANYONE IN YOUR FAMILY ALLERGIC TO DOGS?

WILL PET EVER BE LEFT UNATTENDED WHILE IN YARD?

DO YOU HAVE DOGGIE DOORS, AND DO THEY OPEN INTO A SECURE AREA OF THE YARD?

WILL PET BE CONSIDERED A FAMILY MEMBER?

DO YOU HAVE CHILDREN (IF SO, PLEASE LIST NAMES AND AGES)?

DO YOU HAVE SMALL CHILDREN THAT VISIT YOU FREQUENTLY?

ARE SAFETY MEASURES IN PLACE TO ENSURE THE DOG WON'T ESCAPE WHEN DOORS ARE OPENED?

HOW FAR DO YOU LIVE FROM WATER?

DO YOU HAVE A POOL (IF SO, ARE PRECAUTIONS IN PLACE TO PREVENT THE ANIMAL FROM FALLING IN?

HOW FAR DO YOU LIVE FROM A BUSY STREET?

HOW MANY STEPS DOES IT TAKE TO ACCESS YOUR DWELLING?

DO YOU HAVE STAIRS IN THE HOME (IF SO, CAN THEY BE BLOCKED TO PREVENT THE ANIMAL FROM GOING UP OR DOWN)?

ARE THERE SMOKERS IN RESIDENCE?

DO YOU HAVE A SMOKE ALARM SYSTEM INSTALLED?

DO YOU HAVE A SECURITY SYSTEM INSTALLED?

DO YOU HAVE ELECTRIC FENCING?

ARE YOU FAMILIAR WITH THE LAWS GOVERNING ANIMAL OWNERSHIP IN YOUR COMMUNITY?

ARE YOU PREPARED TO MAKE A LIFELONG COMMITMENT TO AN ANIMAL?

HOW WILL YOU DISCIPLINE YOUR NEW PET?

ARE THERE ANY LARGE BREED DOGS LEFT UNATTENDED IN YOUR NEIGHBORHOOD?

WHO WILL CARE FOR YOUR PETS WHILE YOU ARE AWAY OR ON VACATION?

IN CASE OF EMERGENCY OR ILLNESS, WHO WILL CARE FOR YOUR PETS (NAME, ADDRESS, PHONE NUMBER)?

IN THE EVENT YOU ARE UNABLE TO CONTINUE CARING FOR YOUR PETS, WHO WILL STEP IN (NAME, ADDRESS, PHONE NUMBER)?

PLEASE GIVE 2 PERSONAL REFERENCES WHO KNOW OF YOUR ABILITIES WITH ANIMALS (NAME, ADDRESS, PHONE NUMBERP

REF 1:

REF 2:

PLEASE, TAKE A MOMENT TO TELL US WHY YOU WOULD LIKE TO ADOPT A RESCUED DOG:

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***PLEASE NOTE*** All adoptions are on a 30 day trial basis, with 3 follow up visits required. Any adoption fees paid are non-refundable. These amounts are to assist with saving other animals. Rescued Pets reserves the right to remove the animal if we feel that the home is not a safe atmosphere, or the animal appears unhappy or maladjusted. If issues arise that were undisclosed prior to adoption, or if the welfare of the animal is in jeopardy, we will remove the animal immediately. Our primary concern is for the health and happiness of any animal we place, and we hope that prospective adoptors can understand this policy.

***IMPORTANT*** IF FOR ANY REASON THE PET NEEDS TO BE SURRENDERED, IT MUST BE RETURNED TO RESCUED PETS/PEKINGESE RESCUE ONLY. ALSO, THIS ANIMAL CANNOT BE EUTHANIZED DUE TO ANY MEDICALLY TREATABLE CONDITION WITHOUT FIRST NOTIFYING THIS RESCUE. RESCUED PETS RESERVES THE RIGHT TO EITHER PICK UP THE DOG, OR WE CAN ASSIST WITH TREATMENT COST. BY SIGNING THIS APPLICATION, YOU ARE HEREBY AGREEING TO THIS POLICY.

SIGNATURE(S) OF ADOPTORS:

DATE SIGNED>

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Copy this application over into email, complete, and send back to the email address at the top of the page.