Pacific Pug Rescue
ADOPTION APPLICATION
503.704.3587 -
To help ensure the best possible placement for our rescued dogs, and in order to determine that the proposed adoption is in the best interest of both the dog, you and your family, please complete the following. Please be as thorough as possible. Only completed applications are eligible for review. Mail completed application & $10 Adoption Application Donation to:
Pacific Pug Rescue
15532 SW Pacific Highway C1B, #134
Tigard, OR 97224
Today’s Date ______
Applicant:
First Name ______
Middle Name ______
Last Name ______
Spouse/Partner:
First Name ______
Middle Name ______
Last Name ______
Full Address ______
City ______
State ______
Zip ______
Home Phone ______
E-mail address ______
Cell Phone ______
Do you own or rent your home? Rent / Own
How long have you lived at your current address? ______
If renting, will your landlord provide written permission to keep a dog? Yes / No
Landlord Name ______
Landlord Phone ______
Your Occupation ______
Your Employer ______
How Long Employed? ______
Partner’s Occupation ______
Partner’s Employer ______
How Long Employed? ______
What are the ages of any children living in your home? ______
Names and ages of all members of your household (including yourself):
Pet History
Have you owned a dog before? Yes / No If so, what breed/breeds?
What pets do you currently own? (Please list kinds, numbers, age and sex of each pet):
Are all pets up to date on vaccines? Yes / No
Are they spayed or neutered? Yes / No
If not spayed or neutered, why not?
Do any of your animals have any physical problems? Yes / No If yes, please describe:
Please state your regular Veterinarian/Vet Clinic
Veterinarian/Clinic ______
Phone ______
Full Address ______
City ______
State ______
Zip ______
Do any household members suffer from “pet” allergies? Yes / No
Do your animals get along with other dogs/Cats and other animals? Yes / No
Will the pug have any exposure to children? Yes / No
Why do you want to adopt a Pug?
What are the characteristics you are looking for in a Pug?
What is your preference regarding the following?
Sex: ______
Color: ______
Age: ______
Will you consider something other than your stated preference? Yes / No
How many hours a day will the dog be left alone? ______
Are you willing to house train a Pug? Yes / No
Can you deal with a Pug that may bark? Yes / No
Where will you keep the dog...
During the day? ______
During the night? ______
During overnight family absences? ______
Do you have a fenced yard? Yes / No
How large an area is fenced? ______
What kind of fencing? ______
How high is it? ______
If no, how will you exercise the Pug? ______
Confine him/her? ______
Provide for his/her need to eliminate? ______
Have you ever surrendered to an animal shelter or sold any of your pets? Yes / No
If yes, please explain the circumstances:
What circumstances do you feel justify giving up a pet?
Are you able to spend at least $1,000.00 per year for food and routine medical care for your pet? Yes / No
Has anyone in your immediate family/household ever been convicted of a charge related to cruelty to animals or child abuse? Yes / No
Is there any such charge pending? Yes / No
Has any such charge ever been filed? Yes / No
If yes to any of the above, please explain and give disposition of charge. Use additional sheet if necessary.
References
Please provide the names, email addresses and phone numbers of two non-related individuals who
can serve as references:
1. Name: ______
Email: ______
Phone: ______
2. Name: ______
Email: ______
Phone: ______
What will you do with your dog if you move?
What do you and your home environment have to offer a Pug that has been neglected/abandoned?
Thank you for taking your time to complete this application. By signing below, you attest to the truthfulness of your answers. Falsification of any of the above information will be grounds to disallow your adoption of a rescued pug.
Applicant Signature ______Date ______
Applicant Signature ______Date ______
(If there are two responsible adults in household, both must sign as an applicant.)