Pekingese Rescue Network, Inc.
Dog Adoption Application

Pet ownership is a serious commitment that the entire household needs to consider and agree to before the animal is adopted. We want to ensure that each adoptive household is aware of, willing, and able to accept the physical and financial responsibilities of pet ownership. Not everyone who desires to own a pet is ready to care for one properly. This questionaire will assist us in determining whether your household is prepared to assume the role of responsible caretaker for a rescued animal. We recommend you scroll all the way down to the bottom of the form to see all the data you need to collect before starting to fill it in. We now require a reference from your employer. If we decide to adopt a dog to you, we will also require, at adoption contract signing, your photograph to keep with the signed adoption contract.

Please fill out all fields that fit your circumstances. Keep tabbing from field to field, filling each in if appropriate, until you reach the SUBMIT button at the very bottom (several pages long). When you have completed the form, please click on the SUBMIT Button. Then separately email digital photos of the inside and outside of your home, particularly showing where the dog will be kept, to: codoan @ aol . com (remove spaces). Thank you!

Name of Dog You Want to Adopt:
I. Your Personal Information  
Your Full Name:
Full Street Address, City, State, and Zip Code:
Telephone Numbers: Home:
Work:
Cell:
Your Email Address:
Please List the Other Adults in Your Home, Their Relationship to You, & Their Names:
Number of Children Living in the House:
Please List Ages of Children:
Do the Children Live with You Full-Time:
Do Other Children Visit? If so, What Are Their Ages and How Often Do They Visit:
Are You 21 Years of Age or Older (proof may be requested): Yes No
Your Birth Date: (MM-DD-YYYY)
Your Occupation:
Your Employer:
Address of Work Place:
Employer's Phone:
Work Reference:
Their Name, Work Phone No., Work Relationship:
Occupation of Spouse or Other Adults Living in Home:
Other Adult's Employer Name, Address, & Work Phone No.:
Do You Have a Drivers License and/or Other ID with Your Name & Address? Yes No
Does Anyone in Your Family Have Allergies to Animals, and If So, What Kind:
Does Anyone in Your Household Smoke? No Yes
Does your entire household know that you are considering adopting a pet? If not, why not?
II. In Which Dog(s) Are You Interested?  
Why Do You Want a Dog of This Breed? Have You Had One Before? What Do You Like Most About This Breed? Dislike?
In Which Particular Dog or Dogs of Ours Are You interested?
If no particular one, please note your preferences below,
so we can let you know when such a dog becomes available:
Desire Pure-bred, Mixed breed, or No Preference: Pure Mixed No Preference
Desire Male, Female, or Either: Female Male Either Sex
Desire Dog in What Age Range: Adult (over 1 year) Adolescent
Baby No Preference
III. You As a Pet Owner  
Animals can be expensive to care for (estimated average annual cost if $760 to $1000 for one dog, or between $11,000 and $15,000 over the life of a dog). Are you willing and able to provide adequate food, shelter, and medical care, including yearly checkups and vaccinations, dental cleaning, and treatment for intervening medical problems for an adopted animal?
Why Do You Want A Dog? Breeding? Companionship? Gift? Exercise? Protection:
Where Would It Primarily Stay: Inside, Outside, or Both Equally: inside outside both_equally
Where Would It Stay When You Are Not Home: Loose inside Loose Outside
fenced_run Tie-Out
Closed Crate other
If You Chose Other, Please Explain:
Where Will the Dog Sleep at Night:
Please Describe Your Home Setting: Suburban? Urban? Rural? suburban urban rural
What Type of Home Do You Live In: House Apt Town-house
Condo M_H
Do You Own or Rent Your Home (If You Rent, You Must Provide Proof of Permission to Have a Dog There) Own Rent
Landlord Name and Phone Number:
If You Have a Yard, is it Fenced? If So, What Type, Material, and Height? If Not Fenced, How Would You Keep Your Pet in Your Yard?
If You Have a Fenced Yard, Please Describe Number of Gates and Size of Yard. Are the Gates Always Securely Latched and/or Locked:
If the Dog is Outside Other than for Supervised Activities, Describe What Shelter Would Be Available for It: covered_area shade_trees
shed dog_house other
If Outside Shelter = Other, Please Explain:
Please Describe Your Home's Activity Level: busy-active-noisy
moderately-busy quiet
Do You Have a Pool? Above-Ground or In-Ground? If In-Ground, Is It Separately Fenced:
Do You Believe That A Pet Should Be Spayed Or Neutered: believe yes don't believe
If Not, Why Not:
Are You Making a Life-Time Commitment to This Pet? Yes No
Approx. How Many Hours Each Day Would The Dog Be Left Alone, When, and Where:
How Much Do You Think it Will Cost You to Buy Pet Food Per Year? What Kind of Food Would You Buy? What Kind of Food Did You Feed Previous Pets?
How Much Do You Think Veterinary Care Will Cost You Per Year and Why?
IV. Unexpected Problems  
What Dog Problems Would Make You Return an Animal: barking house-breaking
chewing jumping_up
shyness-fears shedding
digging furniture_damage
no_longer_cute growing_old
illness none
Have You Ever Attended a Dog Training Class? Please Explain When and Why.
If Necessary to Help Resolve Problems, Are You Willing to Crate-Train or Take an Obedience Class: Crate Class
What Other Circumstances Would Make You Return an Animal: Move new_baby
divorce high_cost_care
personal_illness other
none.
If Other, Please Explain:
V. Pets You Have Had in the Past  
Please List All Animals That You Presently Own and Have Owned in the Past (Other Than Fish, Rodents, and Reptiles)
Breed/When Owned/Age/Gender/Neutered/Vacc./Heartworm/Medical Conditions/Etc.:
If You No Longer Have Any of These Pets, Please Explain Why. Did You Turn It In to Animal Control? Did it Die? Did You Give it Away? Has Your Spouse or Partner Ever Turned a Pet In at Animal Control? Please Explain.
Your Vet, Clinic Name, City, and Phone No. so We May Verify How Well Your Pets Were Cared For. Please tell your vet's office to expect our call.
Your First Character Reference (Not a Relative) Name and Phone No.:
Your 2nd Character Reference (Not a Relative) Name and Phone No.:
Name of Any Other Rescue Organizations to Whom You Have Applied to Adopt:
Your Driver's License No. and State:
VI. Pekingese Rescue Network, Inc. Plans to Maintain Continuing Contact With Adopters to Insure the Well-Being and Adjustment of the Pet. Are You Willing to Permit Telephone Calls and Possibly Home Visits To Check on the Pet (Type in yes or no):
VII. IMPORTANT!  
Please separately email digital photos of your home and yard, particularly showing where the dog will be kept, to: codoan @ aol . com (remove spaces).

If at any time the adopter cannot keep the animal, it must be returned to Pekingese Rescue Network, Inc. In addition, each pet adoption is assessed a donation, varying by animal, to help pay veterinary and other expenses. Adoption donations are non-refundable. Adoption donations must be given in advance to place a dog on hold. If for any reason you should decide you no longer wish to adopt the dog that has been held for you, the donation fee will not be refunded.

Please click the SUBMIT button (on the right) now. It will email your application to us, then return you to our homepage. -->