SASS Adoption Application

Adoption Application

S.A.S.S. Save A Shelter Shih Tzu Rescue, Urbana, Ohio 43078

Web: www.sassrescue.com Email: adopt@sassrescue.com
Please Run the Wizard
Application Date *

Month Day Year
Pet Applying For (Name)?
Breed?
Personal Information
Applicant Information
Name: *

First Name Last Name
Home Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail: *
Home Phone: *

Area Code Phone Number
Cell Phone:

Area Code Phone Number
Work Phone:

Area Code Phone Number
Employer Name:
Employer Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Employer Phone:

Area Code Phone Number
Co-Applicant Information

(If you do not have a co-applicant scroll to the bottom and click next)
Name:

First Name Last Name
Home Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail:
Home Phone:

Area Code Phone Number
Cell Phone:

Area Code Phone Number
Work Phone:

Area Code Phone Number
Employer Name:
Employer Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Employer Phone:

Area Code Phone Number

Vet & Training Information
Clinic Name?
Veterinarian's Name:

First Name Last Name
Clinic Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Clinic Phone Number:

Area Code Phone Number
Do you agree to have annual checkups and all vaccinations administered by a vet? *

Yes No
Are you willing to do obedience training with your new dog? *

Yes No
What methods will you use to deter destructive behavior?
What are your feelings about crating your pet?

Personal Information