SMALL DOG RESCUE OF GREATER HOUSTON ADOPTION …



|YORKIE AND SMALL DOG RESCUE ADOPTION APPLICATION |

Date

Name and age: Spouse name and age: ________________________

E-mail address:

Home Phone: Cell phone:

Your occupation Business phone

Spouse’s occupation Business phone

ADDRESS:

SUB DIVISION

Do you live in a house ( ) town house ( ) duplex ( ) condo ( ) apartment ( ) or other?

Do you own ( ) rent ( )

IF RENTING: NAME, ADDRESS & PHONE NO. OF LANDLORD

DRIVER'S LICENSE NUMBER

PLEASE LIST ALL OTHER PEOPLE LIVING IN YOUR HOUSEHOLD, NAMES, SEX AND AGES:

How did you find YSDR?

Why do you want a Yorkie or other small breed dog?

Is there a particular dog that you are interested in?

Do you prefer a male or female or no preference?

Are you willing to adopt a dog of any age? If not, what age would you consider?

Have you ever owned the breed of dog that you are applying for? If so, where, when and from whom was it acquired?

We do not guarantee a dog to be housebroken? Are you equipped to train with love and patience?

How do you plan to house train your pet?

Have you had any experience with an emotionally or physically neglected or abused dog?

Please list names and give details of pets you have living or deceased.

If deceased, please state how old it was and cause of death, if the pet was altered. If not altered, please explain why not? Was it on heartworm preventative? What brand?

Are all dogs that you currently own on heartworm prevention? If so, what brand?

Pet’s name: Breed Sex Age shots heartworm preventative, If Yes , what brand?

Are your current pets altered? If not, please explain why?

Where do your current animals stay? In house ( ) outside ( ) If outside, please explain why?

Are all members of your family agreeable to adopting a dog?

Does anyone in your household have any known allergies to animals?

Who will have primary responsibility for the care of the dog?

How many hours in an average workday would your dog be left alone?

Do you have a fenced yard or fenced area? Please describe.

Do you have a pool? If so, how do you plan to protect your dog from drowning?

Do you have a doggie door? (This is not a requirement of YSDR)

If you have a doggie door, is it locked when you are not at home?

Where will the dog be kept?

During the day? At Night? While you are not at home?

If you are ever away for a few days, who would take care of your dog?

Have you a groomer you plan to use for your new dog? Please give name, address and phone number of your groomer.

Please list your Veterinarian’s name, address and phone number: If there are two people that have apps on the same dog, the vet records will play a big part in one getting the dog of choice.

Please list your previous Veterinarian’s name, address and phone number and any other vet’s you have used now or in the past:

Please list 3 personal references with names, addresses, phone numbers and how related.

We prefer it not to be all relatives.

ARE YOU WILLING TO HAVE A MEMBER OF RESCUE & ADOPTION ORGANIZATION VISIT WITH YOU, BY APPOINTMENT PRIOR TO AND AFTER ANY ADOPTION? Yes ( ) No ( )

If no transportation can be found, will you be willing to travel to collect a dog? Yes ( ) No ( )

We require an adoption fee to defray veterinary and other expenses. Are you willing to do so?

IF ACCEPTED AS AN ADOPTER:

BY SIGNING THIS DOCUMENT, I ACCEPT IT AS A BINDING CONTRACT AND UNDERSTAND AND AGREE TO THE FOLLOWING.

1. Any dog adopted from YSDR is to be an indoor dog and treated as a member of your family.

2. Any dog adopted from YSDR shall be afforded all necessary vaccinations, licenses, heartworm and flea prevention, plus any medical treatment that may become necessary.

3. If for any reason, you can no longer care for your adopted dog, it must be returned to YSDR.

YSDR retains the right to remove a dog adopted from us that has been deemed abused, neglected, or found to be in a situation that may not be in the best interest of the dog.

I hereby give permission for my Veterinarian to release information to YSDR on any pets that I have owned, live or deceased.

YSDR reserves the right to refuse a dog to any applicant.

Any misrepresentation of fact may result in my not being approved to adopt a dog from YSDR.

All information I have given on this form is true and correct.

Additional comments:

PRINTED NAME DATE

SIGNATURE DATE

YORKIE AND SMALL DOG RESCUE, INC

A 501 ( c ) ( 3 ) Non Profit Corporation

Fill this form out and e-mail back to:

Yorkierescue@

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