Name
Date
Address
City
State -- Select -- AL Alabama AK Alaska AZ Arizona AR Arkansas CA California CO Colorado CT Connecticut DE Delaware DC District of Columbia FL Florida GA Georgia HI Hawaii ID Idaho IL Illinois IN Indiana IA Iowa KS Kansas KY Kentucky LA Louisiana ME Maine MD Maryland MA Massachusetts MI Michigan MN Minnesota MS Mississippi MO Missouri MT Montana NE Nebraska NV Nevada NH New Hampshire NJ New Jersey NM New Mexico NY New York NC North Carolina ND North Dakota OH Ohio OK Oklahoma OR Oregon PA Pennsylvania RI Rhode Island SC South Carolina SD South Dakota TN Tennessee TX Texas UT Utah VT Vermont VA Virginia WA Washington WV West Virginia WI Wisconsin WY Wyoming
Zip
Evening Phone
E-mail address
Number of adults in the household
Men / Ages
Women / Ages
Number of children in the household
Boys / Ages
Girls / Ages
Are you expecting a child or planning a family in the near future?
Type of Dwelling: House Apartment Trailer Condo/Townhouse Duplex/Triple Other
Do you own or rent? own rent
If you rent, do you have the landlord’s permission to keep a dog? yes no
Please provide Landlord/Apartment contact information for verification
How many consecutive hours a day are you away from home for work, school etc.?
Will you be hiring a pet sitter if gone a long time or are you close enough to go home during the day?
If interested in a particular pug, please specify who
Are you agreeable to returning the pug, should unforeseen circumstances arise wherein you would no longer be able to keep them?
Would you be willing to allow us to visit your home?
Have you applied with another Rescue Group? If so, which organization?
If out of state, will you make provisions to get the dog?
Color Preference: Fawn Black No preference
Age Preference: Puppy (6 mos.-1 years, rare in rescue) 1 - 6 years 6+ years No preference
Sex Preference: Male Female No preference
How large is your yard (approx.)?
Is it securely fenced? Yes No
If yes, what kind of fence and how tall?
If no, will you fence it if you get a dog?
Do you have a pool? Yes No
If yes, is it securely fenced? Yes No
If your yard is not fenced, how do you plan to insure that the dog receives safe and adequate exercise?
Where will the dog sleep?
Do you plan to keep the dog primarily indoors or out? Please elaborate.
Do you plan to use a crate? Yes No
Please list current pet information:
Breed
Age
Spayed or Neutered?
Stay Indoors or Outdoors
Breed
Declawed?
Spayed or Neutered?
Stay Indoors or Outdoors
Breed
Age
Spayed or Neutered?
Stay Indoors or Outdoors
Have your current pets ever lived with a dog? Yes No
Please provide information on any former pets here:
Species/Breed
How Long Owned
Kept Indoors or Outdoors?
Spayed or Neutered?
Where is pet now? If deceased, cause of death?
Species/Breed
How Long Owned
Spayed or Neutered?
Kept Indoors or Outdoors?
Where is pet now? If deceased, cause of death?
Have you ever had to give up a pet? If yes, please tell us why:
Where did you get this dog(s)?
What type of Heartworm Preventative do you give your dog?
What type of flea control do you use on your dog?
What do you feed your dog (brand/type)?
Is your dog spayed or neutered? Yes No
Why or why not?
When nobody is home, where does your dog stay? In the yard In a crate In the garage In the house, confined to an area In the house, not confined to an area In the house with a doggie door In an outdoor dog run/pen
Do you consider your current dog(s) aggressive or submissive to other people? Animals?
What amount of time and effort, per week, do you want to devote to training your dog? 3-5 hours 5-7 hours 7-10 hours 10+ hours
Which family members would be expected to assist in home training?
What is your definition of disciplining your dog?
What are your training objectives?
What makes you a good pet owner?
Are you aware of pug health problems? Yes No
If yes, what problems do you foresee (please explain)?
Are you willing to take care of said problems should they arise, even if he/she requires daily medication? Yes No
Are you aware that pugs shed 365 days a year? Yes No
Did you know that pugs snore? Yes No
Pugs are companion animals and they want to be with you constantly. Pugs were bred solely for companionship. Are you prepared for this? Yes No
Do you realize that pugs can live upwards of 14 years and are you committed to caring for one for that long? Yes No
How did you find out about us?
Please let us know anything else that would make you an ideal candidate for a rescue pug:
Reference #1 (current vet if applicable, or the vet that you plan to use in the future)
Reference #2
Reference #3
