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NAME:
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ADDRESS
CITY, STATE, ZIP
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PHONE
NUMBERS:
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EMAIL
ADDRESS:
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Names & Ages of
ALL PEOPLE
Living in Home:
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Rent/Lease a single
family home
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WHICH BEST
DESCRIBES
YOUR CURRENT
RESIDENCE:
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Own a single family home
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Rent/Lease an
apartment,
townhouse, or
condominium
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Own a townhouse or condominium
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If you rent/lease, please include your landlord or
property manager's name & phone number.
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What are your occupations ?
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How long have you lived at your
residence?
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Please tell us why you want a dog?
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Please tell us a little about your lifestyle, your family, including
any special activities in which your dog would be included. (If you
have any special requirements or requests for a dog, please let us
know so that we can more carefully match a dog to your lifestyle.):
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Do you have a swimming pool?
If yes, do animals have free access
to it?
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What behaviors would cause you to
give up your dog?
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If you do adopt a rescue dog and
decide to give it up, do you agree
to contact us and make arrangements
to get the dog back to Bluegrass?
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Is your yard, or a portion of your
yard, securely fenced?
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If you do not have access to a fenced area, please
explain how you plan to exercise your adopted pet &
allow it to relieve itself?
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Do you have a Preference?
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MALE, FEMALE, NO PREFERENCE
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ARE YOU WILLING TO:
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Accept a dog with SPECIAL MEDICAL NEEDS?
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Accept a dog with a history of NEGLECT/ABUSE
who needs extra love & attention?
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WHICH RESCUE DOG ARE YOU
INTERESTED IN, PLEASE LIST NAME?
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Accept a dog with BEHAVIOR PROBLEMS who
requires special training?
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Accept a dog that is a MIX BREED ?
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HISTORY OF PET OWNERSHIP
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PLEASE LIST ALL ANIMALS CURRENTLY LIVING IN YOUR HOUSEHOLD
NAME
TYPE OF PET (IF DOG, LIST THE BREED)
GENDER
AGE
HOW LONG OWNED
WHERE KEPT
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PLEASE LIST DOGS YOU HAVE OWNED IN THE PAST
DOG'S NAME
BREED
AGE
HOW LONG DID YOU OWN
WHAT HAPPENED TO THE DOG
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REFERENCES
Please provide THREE names as references. Include the following if you have them.
VETERINARIAN & Phone number
GROOMER & Phone number
Other references could include Please include all references' phone number !!
NEIGHBOR
A small breed OWNER
ANYONE WHO HAS KNOWLEDGE OF YOU WITH YOUR DOGS
(To speed up the application process, please call your references and tell them to release information to us.
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CARE & RESPONSIBILITY
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Have you previously owned a Shih Tzu,
Maltese or small breed?
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What is your definition of disciplining a dog?
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Does anyone in the household have any known allergies to animals?
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Does anyone in the household smoke?
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Where will your rescue pet sleep at night?
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How long will your rescue pet be left outside?
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Approximately how many hours a day will your rescue pet be alone?
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If yes, who will take care of your pet when you are away?
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Do you travel frequently?
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COMMENTS
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Signature of Applicant
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Date of Application
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