SHIH TZU Rescue - Adoption Application
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Phone: 954-680-6456

Thank you for your interest in adopting a companion dog through Shih Tzu Rescue.  We receive numerous applications on a daily basis and try very hard to match the "right" dog with the "right" human companion.  To facilitate this, please complete the following adoption application.  There are no "right" and "wrong" answers; the questions are merely a guide to help determine your priorities and to help us select the most appropriate homes for our dogs.  Our decisions are made based on the Rescue Committee's knowledge of the rescued dog's background from either the previous owners, our volunteers, or those who have provided foster care.

Before proceeding, please note that ALL references are mandatory.  If you do not include  references, your application will not be processed.  All information entered will only be used toward your adoption and is strictly confidential.

We do not ship our companion animals.
We do not adopt to homes with small children.
We adopt only in the south Florida area but do make some exceptions for areas around Tampa, Sarasota and Central Florida.

There will be a required Adoption Donation fee ranging from $150-$500


Fields with * are required

*Name  
*Age
 
*Driver's Lic. #  
*Marital Status
 
Spouses Name
Spouses Age
*Address Line 1  
*City
 
Address Line 2
*State
     *Zip  
*Home Phone #  
*Cell Phone #
 
*E-Mail Address  
*Best Time to Call:
 
*What is the best way to contact you?
 
*Employer:
 
*Job Title:
 
*Work Phone #
 
*Working Hours:
 

*Where did you hear of us?  
*Have you applied to adopt a dog with other rescue group(s) If so, please list.  
*Why are you looking to adopt a dog, and why did you choose to adopt rather than buy from a pet store or breeder?  
*What dog(s) are you interested in adopting?  
*Why do you want a companion animal?  
*What made you decide to adopt this particular companion animal over the others?  
*Have you had any previous experience with this "breed"(s)  
*What temperament are you looking for in a companion animal?  
*Type of Home

Single Family House
Apartment/Condo
Town House
Mobile Home
Duplex

If Condo or Home Owner Assoc., what are their pet restrictions?
Property Management/ Manager name:     
Phone #
*Do you rent or lease your home?

Yes          No

Does your landlord allow pets?

Yes          No          Don't Know

Landlord's Name:     
Landlord's Telephone:
*How many adults live at home?  
*Relationship to applicant:  
*How many children live at home?       
*What are the children's ages?  
*Relationship to applicant:  
If you currently have no children and are planning on starting a family, how will this affect the future of your companion animal?
*Who will have primary responsibility for the care of your companion animal?  
*Has anyone in the household ever had an allergy to animals?

Yes          No

*Do you have any health issues that would prevent you from providing your companion animal with a lifetime home?

Yes          No

If yes, have you consider our Foster Program?

Yes          No

*Will you allow us to visit your home before or after you adopt your companion animal?

Yes          No

*Approximately how many hours a day will your companion animal be alone:

0-2 hours
3-5 hours
6-8 hours
9-12 hours
12 or more hours

*How much time can you dedicate to your companion animal on a daily basis?  
*Your newly adopted companion animal's living situation (check all that apply) Will live indoors
Will live indoors & outdoors
Will live in garage/patio/balcony
Will live outdoors only
Will live outdoors only with a dog house/shade
*When home alone,, your newly adopted companion animal would stay where? (check all that apply) Loose indoors
Confined to one room
Kept crated indoors
Kept crated outdoors
Outside loose in fenced yard
Outside loose in unfenced area
Tied/Chained outdoors
*How will you exercise your companion animal? (check all that apply) Leash walks daily
In outdoor kennel/run
Free run of fenced yard
Free run of invisible fenced yard
Free run of unfenced yard
*Where will your companion animal sleep?  
*Where will your companion animal stay when you are away from home (vacations, etc)  
*How much money are you willing to spend on your companion animal yearly?  
*Are you aware that many dogs are prone to allergies?

Yes          No

*If your companion animal develops an allergy, are you willing to medically treat this condition?

Yes          No          Don't Know

*Under what circumstances would you consider finding somewhere else for your companion animal to live?  
*What would you do if you could not keep your companion animal?  
*What behaviors would you consider unacceptable?  
*What would you do to correct the above behavior?  
*Do you currently have any pets?

Yes          No

 


Please list any companion animals you have now or have had in the past ten years

Name of Pet:
Type of Pet:
Breed
Sex
Spay/Neutered
If no, explain
How long with you?
What happened to the pet

Gave Away
Ran Away
Stolen
Hit by Car
Died (explain)

Name of Pet:
Type of Pet:
Breed
Sex
Spay/Neutered
If no, explain
How long with you?
What happened to the pet

Gave Away
Ran Away
Stolen
Hit by Car
Died (explain)


Name of Pet:
Type of Pet:
Breed
Sex
Spay/Neutered
If no, explain
How long with you?
What happened to the pet

Gave Away
Ran Away
Stolen
Hit by Car
Died (explain)

Name of Pet:
Type of Pet:
Breed
Sex
Spay/Neutered
If no, explain
How long with you?
What happened to the pet

Gave Away
Ran Away
Stolen
Hit by Car
Died (explain)


If additional space is needed please continue in the comments section (at the end of the application).

Personal References

Please list three personal reference, they can include neighbors, relatives, friends, etc.

Name
Address
City
State
Zip
Telephone
Relationship to Applicant
Name
Address
City
State
Zip
Telephone
Relationship to Applicant

Name
Address
City
State
Zip
Telephone
Relationship to Applicant

Veterinary References

Please list the veterinarian that you have used in the past (if applicable). If you have used more than one vet, throughout your pet-owning years, please list additional Vets below as well. If you have never had a pet please list the vet that you plan to use on your newly adopted companion animal.

Veterinarian's Name:
Hospital Name:
Hospital Address:
City:
State:
Zip:
Telephone:
Veterinarian's Name:
Hospital Name:
Hospital Address:
City:
State:
Zip:
Telephone:

Groomer:
Business Name:
Groomer Address:
City:
State:
Zip:
Telephone:

Did you use a Heartworm Preventative on your past companion animals?

Yes          No          N/A

Do you use a Heartworm Preventative on your current companion animals?

Yes          No          N/A

If yes, what brand?
If yes, where did you purchase it?
*Are/Were your companion animals vaccinations kept up to date? (select most applicable answer)  
*What age companion animal would you consider adopting?  
*Would you consider adopting an abused companion animal?

Yes          No

*Would you consider adopting a special needs companion animal?

Yes          No

*Would you consider adopting a companion animal who requires additional behavioral or house training?

Yes          No

*What temperament do you like your companion animal to have?  
Additional Comments:
*I agree to return the adopted animal to Shih Tzu Rescue if I can no longer care for it

Yes          No

*I am financially/physically able to care for the adopted animal. I understand the expenses involved in pet care and I'm able & will meet these requirements.

Yes          No

*I am stating that the information in the above pages is true, as typed, and that if any information is found to be false Shih Tzu Rescue will reclaim the said animal

Yes          No

*I understand that should I adopt from Shih Tzu Rescue, an adoption fee between $100.00 and $500 (to be determined by Shih Tzu Rescue) is part of the adoption process. This adoption fee helps with the costs of caring for all of the rescued dogs.

Yes          No

 *I have indicated that this is a valid and legal substitution for your written signature on this legal document.

Yes          No

 If all required fields are not entered, the application cannot be processed.

Please note that Shih Tzu Rescue reserves the right to refuse adoption.

Copyright  2005 Shih Tzu Rescue, Inc.  All rights reserved.
Revised: 11/24/08