Pacific Pug Rescue Adoption Application

Pacific Pug Rescue Adoption Application

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.
Thank you for your interest in adopting a rescue pug! Puppies almost never come into rescue and young pugs under the age of 4 are also not common. In general most of the pugs we have are age 9 or older. We are not accepting applications for young pugs at this time as they are a very small percentage of what we rescue.Thank you for your patience and understanding.
All correspondence regarding your application will be done by email. If your email filter is set to exclusive you will need to check your junk and spam folders frequently so you do not miss updates on the status of your application.
Full Name

First Name Middle Name Last Name
Phone Number

Area Code Phone Number
E-mail
Spouse/Partner

First Name Middle Name Last Name
Co-Applicant Phone Number

Area Code Phone Number
Co-Applicant E-mail
Current Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
How long at this address?

Names and ages of all members of your household (including yourself):
Employment History

Employer

What are your hours and okay to contact you there?

How Long Employed Work Phone
Spouse/Partner Employer

What are your hours and okay to contact you there?

Work Phone
Rent or Own *

Rent Own
If you rent, please provide:
If you rent, please provide :

Option 1 Option 2 Option 3
Landlord's Name

First Name Last Name
Landlord's Phone

Area Code Phone Number
Landlord's E-mail
Pet History
Have you owned a dog before? *

Yes No
If so, what breed//breeds?
Please list your regular Veterinarian/Vet Clinic
Veterinarian Phone

Area Code Phone Number
Do any household members suffer from “pet” allergies?

Yes No
List all pets currently residing in your home and their ages.
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
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

Male Female No Preference
Color

Fawn Black Brindle No Preference
Age *

Adult Senior No Preference
Age *

Adult (5yrs-8yrs) Senior (8+ yrs) No Preference
Will you consider something other than your stated preference?

Yes No
Are you interested in a particular Pug?
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?
At night?
If you are away from home overnight?
Do you have a fenced yard?

Yes No
Kind of fencing and height?
If you do not have a fenced yard, how will you:
Exercise the dog?
Provide for their need to eliminate?
What is the maximum number of hours your dog will be left alone during a 24 hour period?
Where will he/she spend this time?
How much time each day will you spend with your dog?
How would you deal with a dog that is destructive when left alone?
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
Please provide the names, email addresses, and phone numbers of TWO NON RELATED individuals who can serve as references:
Reference #1 *

First Name Last Name
E-mail *
Phone Number *

Area Code Phone Number
Reference #2 *

First Name Last Name
E-mail *
Phone Number *

Area Code Phone Number
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 entering your full name 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.

If there are two responsible adults in household, both must sign as an applicant.
Applicant Signature

First Name Last Name
Applicant Signature

First Name Last Name
"Signed"

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Pacific Pug Rescue Adoption Application

Pet History

What is your preference regarding the following?

Thank you for taking your time to complete this application. By entering your full name 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.