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Adoption Application for The Loved Pug

Name:__________________________________
Spouse/Partner________________________
Address:__________________________
City:_________________
State:_____ Zip:_________
Phone: Home:________________Work:_______________
Spouse/Partner:_______________
E-mail Address:____________________________
Employed by (Name & City)_______________________________
Hours worked per day_____
Occupation/Profession:______________
Spouse’s Occupation/Profession________________
Spouse/Partners Employer: ____________________________
Hours worked per day______
Names and Ages of all other people living in the home:________________________________
Personal Reference: (name, address and phone number)______________________________
____________________________________________________________________________
How often do you travel on business?___________________
Pleasure?___________________
Do your animals travel with you? ___
All of the time ___ Sometimes ____ Rarely ____Not at all
Are you planning a move in the next year? ___Yes ___No
When and where?____________
Are there likely to be any major changes in your lifestyle in the near future?
(such as pregnancy, adoption, care of relative, etc.?)
If yes, please describe:______________________
Do you live in a: ____House ___Condo ___Apartment ___Mobile Home ___RV Park
With parent/relatives _____Other_____________________________________________
Does your Homeowners Association, Apartment or Mobile Home allow pets? ___ Yes ___No
If so, what size restrictions and what number of pets are allowed?________________________
Do you Own? ____ Rent?____ How long have you been at this address?_________________
Do you have an enclosed: ___ Front Yard, ___ Back Yard, ___ Patio How tall are fences?:___
Do you have a pool or spa? _____ Yes _____ No
If yes, are they enclosed? _____Yes _____ No Do you have a balcony? ___ Yes ___ No
If yes, what is the space between the rails?______
Will you reinforce or enclose areas if we request? _____Yes _____ No
Will you put a lock on all gates? ___ Yes ___ No Are all windows screened?___ Yes ___No
Do you have stairs? _____ Inside _____ Outside Are any stairs open backed?__________
Does your home have air conditioning? _____ Yes _____ No
Pesticides, slug/snail pellets and other chemicals such as antifreeze are toxic and can kill animals.
Do you agree not to use any of these in areas your pug can get to? ___Yes ____No
What pets do you currently own, and their breed, sex and age:__________________________ ____________________________________________________________________________
Which ones are spayed/neutered?________________________________________________
Are they current on immunizations? ___ Yes ___ No
Who is your current Veterinarian? (name, address and phone)__________________________ ____________________________________________________________________________
Have you ever taken an animal to a shelter/pound? _____ Yes _____ No
If yes, please explain:_____________________________________________________________________ ___________________________________________________________________________
What justify's, in your mind, getting rid of a Pug?______________________________________
Who will be responsible for the pugs care?_____________________________________
Does anyone in your household not want a Pug or dislikes dogs? ______ Yes _______ No
Have you ever owned a pug before? ____Yes ___ No If not stated above, when?_________
Where will you keep your pug during the day or when you are gone from home?(please be specific) __________________________________________________________________
Where will your pug sleep at night? __________________________________________
Where do your other pets sleep?_________________________________________________
Will your pug be restricted from certain rooms of the house? _____ Yes _____ No
If yes, which?_________________________________________________________________
Will you allow your pug on the furniture?_____ Yes _____ No
How many hours a day, on average, will your pug be alone?___________________________
Is anyone in your household allergic to animals? _____ Yes _____ No
How does your spouse/partner feel about dogs?_____________________________________
Can you deal with a pug who snores? ___ Yes ___ No
Can you deal with a pug who sheds alot? ___ Yes ___ No
With one who scratches? ___Yes ___No Who barks? _____ Yes _____ No
Who has housebreaking accidents? _____ Yes _____No Who licks ? ___ Yes ___ No
Will you use a crate? ____Yes ____No
If a pug has a housebreaking accident, what should you do? _____
Are you willing to house train a pug? _____ Yes _____No
Have you ever bred dogs? _____ Yes _____No If yes, when?________________________
Are you open to a special needs pug, such as one who is blind, deaf, or has other disabilities? _____ Yes _____No
Is there any type of pug you would not accept? _____Yes _____No If yes, please explain:_________________________________________________________________________________________________________________________________________________
Would you object to a home visit by a representative of The Loved Pug? _____ Yes _____ No
If Yes, why?__________________________________________________________________
Would you be willing to adopt a pair of pugs? _____ Yes _____No
Are you willing to take a pug to regular veterinary checkups? _____ Yes _____No
Are you willing to let The Loved Pug come to your home for house checks? ___Yes ___ No
Is there anything else you think we should know about you, your current pets, your family, etc.?
________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________
____________________________________________________________________________

By my signature below I guarantee all information provided above is truthful and accurate.

Signature of Adoption Parent_____________________________________ Date:_____________

Signature of Spouse/Partner:___________________________________ Date: ____________