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
Application Date

MonthDayYear
Pet Applying For (Name)?
Breed?
Personal Information
Applicant Information
Name:

First NameLast Name
Home Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail:
Home Phone:

Area CodePhone Number
Cell Phone:

Area CodePhone Number
Work Phone:

Area CodePhone Number
Employer Name:
Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Employer Phone:

Area CodePhone Number

Co-Applicant Information

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

First NameLast Name
Home Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail:
Home Phone:

Area CodePhone Number
Cell Phone:

Area CodePhone Number
Work Phone:

Area CodePhone Number
Employer Name:
Employer Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Employer Phone:

Area CodePhone Number

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

First NameLast Name
Clinic Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Clinic Phone Number:

Area CodePhone Number
Do you agree to have annual checkups and all vaccinations administered by a vet?
Are you willing to do obedience training with your new dog?
What methods will you use to deter destructive behavior?
What are your feelings about crating your pet?

Personal Information