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Adoption/Foster Application

Wichita Pug Rescue Adoption/Foster Application
We are now using this form for both adoption and fostering.  Please indicate if adopting or fostering on the first line.

Note:  This application will only work on a computer, no phones or tablets.

BEFORE FILLING OUT APPLICATION, BE SURE YOUR CURRENT PETS ARE UP TO DATE ON ALL SHOTS.  WE CAN NOT ADOPT ANY PUG INTO A HOME WITH PETS NOT CURRENT ON ALL VACCINATIONS. 


Animal's Name: *   Indicate Animal for adoption OR Fostering
CONTACT INFORMATION
First Name: *
Last Name: *
Address: *
City: *
Zip Code: * (5 digits)
State:
Daytime Phone:
Home Phone:
Cell Phone:
Email: *
Profession/Employer: *
Profession/Employer of spouse or significant other: *  
ENVIRONMENT
Years at current address:  
Your current home is  OwnedRentedOther
If other:  
Your current home is a  HouseApartmentCondo    
TownhouseOther
If other:  
If rental, lease allows pets?   YesNo
If yes, property management name and phone number: :
Is your yard completely fenced? (Yes/No):
If Yes, what type of fence?:
If Yes, what is the height of the fence?:
If Yes, are the gates kept locked? (Yes/No):
Can a stranger gain access to your yard? (Yes/No):
Do you have a pool? (Yes/No): *
If Yes, what type (in ground or above)? :
Is your pool fenced in? (Yes/No):
INFORMATION ON THE HOUSEHOLD
You are at least 21 (Yes/No): *  
Household Member 1 - Name:
Household Member 1 - Relationship:
Household Member 1 - Age:
Household Member 2 - Name:
Household Member 2 - Relationship:
Household Member 2 - Age:
Household Member 3 - Name:
Household Member 3 - Relationship:
Household Member 3 - Age:
Household Member 4 - Name:
Household Member 4 - Relationship:
Household Member 4 - Age:
Additional Household Members :
Do members of the Household have allergies or asthma? (Yes/No): *
If yes, some details please:
Do you have regular visitors (human or animals)? (Yes/No): *
If yes, please explain:
How many hours on average will your new pet be left alone on weekdays: *
How many hours on average will your new pet be left alone on ends: *
PET HISTORY
Do you or have you owned a pet? (Yes/No): *
If Yes (first 5)      Type (dog, cat, etc.)  Breed     Age    Name       How long owned?   Still have?
Got more than 5? How many?:
Have you ever had to give up a pet(s)? (Yes/No):
Veterinary used for current/previous pets and phone number:      Name                                                     Telephone No.

Veterinary you plan to use for your new pets & phone #:      Name                                                    Telephone No.

How frequently do/did your pets go to the vet?:
How frequently do you plan to take a new pet the vet?:
Please provide brief significant medical history of current or previous pets.:
Are/were your pets on flea/tick preventative? (Yes/No):
If Yes, what type?
Are/were your pets on heartworm preventative? (Yes/No):
If Yes, what type?
Preventatives you plan to use:  (Y/N)   Flea                           Tick                         Heartworm


WHY ADOPT?
I am interested for: *   Myself                        My Family                     Other


I am interested in: *    A puppy                   A younger dog (1 to 6)              An older dog (7 or older)


I am interested in: *  High energy pet                      Medium energy pet                     Low energy pet


Please explain why: *
Please explain why you are interested in this particular pet: *
Who will be responsible for feeding with your pet?: *
Who will be responsible for exercising/playing with your pet?: *
Who will be responsible for your pet's expenses?: *
Where will your pet stay when you are out of the house?: *
Where will your pet stay when you at home?: *
Where will your pet stay overnight?: *
What will you do with your pets while you are on vacation?: *
Do you plan to crate train your new pet? (Yes/No): *
Do you plan to handle chewing, destruction or any other behavioral issues?: *
We may require cerain dogs to attend training classes. Is this acceptable? (Yes/No): *
Are you planning to move in the near future? (Yes/No): *
If you had to move, what would you do with your pets?: *
REFERENCES AND PERMISSIONS
Please provide two references and phone numbers: *   Name                                                                Telephone No.


May an authorized representative of Wichita Pug Rescue visit and inspect your home? (To affirm please enter your initials or name.) *
I authorize a representative of Wichita Pug Rescue to contact the veterinarian office(s) named above to confirm the medical records/histories of my pets (To affirm please enter your initials or name.)*
I understand that if I am unable to keep a pet adopted from Wichita Pug Rescue, I will return the pet to Wichita Pug Rescue.
(To affirm please enter your initials or name.)
 *
I understand that if I am unable to afford proper vet care for a pet adopted from Wichita Pug Rescue, I will contact Wichita Pug Rescue for guidance and assistance(To affirm please enter your initials or name.)*
How did you hear about Wichita Pug Rescue?:
 Comments?:  

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