Adoption Application

Please complete the form below.  For any fields that you do not have an answer for please type N/A.  Please make sure every field that has a star is filled out, even if it's just with N/A, otherwise the form will not submit.  When the form is submitted correctly you will receive a confirmation message on the screen.

Date	*
PREFERENCES
Do you currently have an application submitted with any other rescue organizations?	*	No Yes
If you answered 'Yes', please note which ones you have applied to and give approximate dates.
Is there a dog that you are particularly interested in on our website? This helps us to understand the type of dog you are applying for.
Please list the name of a dog who would be your "second" choice.
Would you be willing to adopt another available pug if the ones you indicated aren't available, as long as they match your other criteria?	*	Yes No
Please select any of the following pug mixes you are willing to adopt:		Puggle (Pug/Beagle) Chug (Pug/Chihuahua) Bug (Pug/Boston Terrier) Pugshire (Pug/Yorkshire Terrier) Other Pug Mixes
Please check all of the behavioral preferences you would like for your prospective adoptive dog.	*	Good with children Good with other dogs Good with cats Crate-Trained Active/Loves Walks Couch Potato
Please check the age range you are looking for in your prospective adoptive dog.	*	Puppy (1-3) Adult (3-8) Senior (8+ years) Any
Would you be willing to adopt a dog with health problems?	*	Yes No
Would you be willing to adopt a dog that is not housetrained?	*	Yes No
Would you be willing to adopt a dog with behavioral issues?	*	Yes No
Please explain the gender, activity level, and personality of a pug you would like to adopt. Please be as detailed as possible so we can ensure we find the most suitable match.	*
CONTACT INFO
First Name	*
Last Name	*
Email Address	*
Phone Number (Home)	*
Phone Number (Cell)
Address	*
City	*
State / Province	*	- - Choose One - - - - US States - - AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY - - Canada Provinces - - AB BC MB NB NL NT NS NU ON PE QC SK YT
Zip / Postal	*
What is the best way to contact you?	*
HOME & CARE
Please list the names & ages of the persons living in your household.	*
Do you own or rent your home?	*	Rent Own
If you rent your home, please provide contact information for the property owner or property management company.
Landlord's Name
Landlord's Phone Number
What type of home do you have?	*
Do you have air conditioning in your home?	*	Yes No
Does anyone in your home smoke?	*	No Yes
How many years have you resided in your current home?	*
If you move, what will you do with this pet?	*
Where will the pug be kept while at work and/or when no one else is home?	*
Where will the pug be kept if you go on vacation?	*
On average, how long will your pug be left alone most days?	*
Who will be responsible for this pet?	*
How do you plan on exercising your pug?	*
Where will your dog eliminate? Check all that apply.		Grass Pavement Wee-Wee Pads
Have you researched the average yearly cost of caring for a pug and do you understand that unexpected costs may arise with having a pet?	*	Yes No
Brifely explain the health issues you are aware of with a Pug.
REFERENCES
Vet: Name
Vet: Address
Vet: City
Vet: State / Province		- - Choose One - - - - US States - - AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY - - Canada Provinces - - AB BC MB NB NL NT NS NU ON PE QC SK YT
Vet: Zip / Postal
Vet: Phone Number **Please call your vet and authorize them to release information to us**
Professional Reference Check: Name (employer / co-worker )	*
Professional Reference Check: Relationship	*
Professional Reference Check: Phone Number	*
Professional Reference Check: Name (employer / co-worker )	*
Professional Reference Check: Relationship	*
Professional Reference Check: Phone Number	*
CURRENT PET(S) INFO
Current Pet(s). Please list all.
Breed & Age. Please list all.
Spayed/Neutered		Yes No
Describe the personality(ies) of your existing dog(s). Submissive? Dominant? Aggressive? Playful? Friendly? Please give as much detail as possible.	*
If any of your pets are not spayed or neutured, please explain why:	*
If you have a lost a pet as a result of an accident, or it died at an early age, please provide details.	*
PROFILE Q&A
Are there plans for any children in your future?	*
Brifely explain the reasons you are most attracted to adopting a Pug and not another breed.	*
Tell us about you - i.e. what you do for a living, activities, hobbies, etc.	*
How do you envision you and your new pug spending time together? Please be specific and provide examples as this information helps us to identify the best personality and activity level for your potential match.	*
What do the weekends look like for you and/or your family? ie Quiet time at home, lots of hiking and outdoor activities, lots of family parties.	*
Why should we choose you as a forever home for one of our pugs?	*
Part of the application process includes a virtual home visit. Please attach some photos of your home, including outdoor space if applicable, as well as the rooms your pug will have the most access to. Please make sure the photos are each less than 1MB in size. YOUR APPLICATION WILL NOT BE PROCESSED WITHOUT HOME PHOTOS.
Home Photo #1	*
Home Photo #2	*
Home Photo #3	*
Home Photo #4
Home Photo #5
Home Photo #6
When you click the Submit button you will be taken to the PayPal site to pay the $15.00 application fee. Your application will not be processed until we receive this fee from you. We appreciate your cooperation.
TO BE FILLED OUT BY RESCUE TEAM MEMBER
Reference #
Status