Rescue Application

Shih Tzu Rescue Application for Adoption
ME and MY FAMILY
Full Name*

First NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Are you at least 21 years of age or older?*

YesNo
Please Note: We must know your state to process the application and you must be 21 years old to complete an application. If you do NOT include an email address, we may not be able to process your application.
Number in household?*
Children? If Yes, what age?

Please tell us the name, age and sex of each of the members of your household.*
Are you expecting a child, or planning a family in the future? (Many toy breeds and Shih Tzu are not good with small children and we would not want to place a dog who didn't like children with anyone who was planning a family.) If yes, will this will affect any of the living conditions of the animal you are wanting to adopt? Please explain:
Does anyone in your household smoke? (Some pug nose dogs do have respiratory problems with second hand smoke.)*
Preferences
Please check any preferences on sex. Please note:The average age of a rescue is between2 - 7 years of age and all rescues will be spayed/neutered before adoption. NO EXCEPTIONS! Please don't ask us for an unaltered dog. Shih Tzu frequenty live 16 - 18 years.If you prefer a younger Shih Tzu, your wait may be slightly longer. We rarely have puppies.
Sex?*

FemaleMaleNo preferenceOther
If you are interested in a particular dog, please tell us the dogs name and which petfinder site you saw it on. The application will be forwarded to the family fostering that dog.
Have you applied with any other rescue group(s) to adopt? If the above answer is yes, please tell us the names of the other groups you have applied to.
Are you willing to travel to pick up your new family member? (Many of our dogs are not fostered locally)*

History of Pet Ownership
What animals currently live in the household? (Please list type of animal, sex, altered or not, age and how long you have owned them, and are they inside or outside animals)
Please list any dog you have owned in the past, name, breed, how long owned, explain what happened to it, including the age it died or left you.

All of the information I have provided is true and complete to the best of my knowledge.
Should a dog be placed with me it will reside in my home as a pet. I agree to provide the dog with adequate food, water, shelter, affection and medical care.
Choose ONE:*

I ACCEPTI DO NOT accept
Signature of applicant
Date

MonthDayYear
Date
Should be Empty:

Shih Tzu Rescue Application for Adoption