Me & My Family:

Name:    

Address:    

City:    

State:    

ZIP Code:    

Home Phone:    

Work/Cell Phone:     

Best Time to Call:    

EMAIL:    

Number in Household:    

Children under 18?     

If yes, what ages are they?    

Housing:

Do you rent or own your home?       

Are there restrictions on this property regarding pets?     

Does your city have any restrictions regarding the number of pets you can have? If yes how many?     

Do you have a fenced yard?    

If you do not have a fence, how will the dog exercise and relieve itself?

 If/when you move, will you seek housing that allows pets?

Preferences:

Gender preferred    

Is there a specific dog you are interested in?

Are you willing to adopt a dog with special medical needs?

Are you willing to adopt a dog with a history of abuse or neglect?

Are you willing to adopt a dog with behavior issues requiring special training?

Are you willing to consider a Shih Tzu mix?

Would you consider adopting a pair if they they cannot be separated?

Have you ever had a Shih Tzu before?

If not, are you aware of the grooming requirements and common health problems of a Shih Tzu?  

Tell us what qualities you are looking for in a dog and what qualities you wish to avoid.

Care & Responsibility:

Are you willing to pay a groomer to groom your Shih Tzu?

Or will you purchase the supplies to groom your Shih Tzu yourself?

Are you willing to spend at least one hour a week brushing your Shih Tzu, which is in addition to the other grooming needs?

Are you willing to pluck the hair out of the ears monthly to prevent infection and clean the eyes daily if necessary?

Have you considered the cost of both routine veterinarian and non-routine emergency care, especially as the dog gets older?

Approximately how many hours a day will your Shih Tzu be left alone?

Where will your Shih Tzu be when left alone?

Where will your Shih Tzu sleep at night?

How long will your Shih Tzu be left outside?

Who will have the primary responsibility for caring for your Shih Tzu?

Do all members of your family agree on adopting a Shih Tzu?

Does anyone in your family have allergies?

What will you do if a current family member or your pet cannot get along with your new Shih Tzu?

Are you willing to take the time to re-housetrain your Shih Tzu during the transition to your home?

How would you discipline your Shih Tzu?

Do you have someone who will watch your Shih Tzu when you are out of town or on vacation? Who?

History of Pet Ownership:

What dogs do you currently have?

Breed/Gender/Spayed or Neutered/Age/How long owned/Where kept?

Do you have any other pets? If yes, please describe.

Please list the dogs you've had in the past.  Name/Breed/ Gender/Age/ How long owned/What happened to the dog.

References:

Please provide THREE references, including your veterinarian and groomer. If you rent, you MUST include your landlord as a FOURTH reference.  Other references may include a neighbor or anyone who has a knowledge of you with dogs. Only one reference may be a relative. Your application will not be considered if this section is not complete. or own your home?

NOTE:  Please be sure your references know we will be contacting them for information.

Vet / Phone Number

Groomer / Phone Number

Landlord / Phone Number

Personal Reference 1 / Phone Number

Personal Reference 2 / Phone Number

Personal Reference 3 / Phone Number

I understand I will be put on a list of people wishing to adopt a dog. The family considered the best match for the dog will be given first priority to obtain the dog.

I agree to pay an adoption fee to help cover the operating cost of rescue and to cover medical expenses and care of the animal.

I understand someone will contact my references and visit with me in my home prior to adoption.

All of the information I've provided is true and complete to the best of my knowledge.

Date of Application

Signature of Applicant