Adoption Application

All of our pugs are wonderful, special little creatures who deserve a home, regardless of age or special needs. Even though we cannot guarantee the future health of our pugs, we can guarantee the loyal unconditional love and companionship they will bring into their new homes. Please, if you have room in your heart to offer an orphan pug a forever home, fill out an application. If you are not 100% committed, or if you are looking for an inexpensive, healthy young pug, you need NOT apply to our rescue. We care deeply about each of our pugs. We will only place them in homes that promise to provide unconditional love forever.

Instructions: Please fill out all information applicable in as much detail as possible. Use TAB or your curser to move from field to field. We will keep your application on file for one year. Please be patient. It is sometimes impossible to reply to every applications as they come in.

CPR reserves the right to refuse any adoption.

Personal Information:

Name:

Address:

City:

State:

Zip:

Home Phone Number:

Work Phone Number:

E-mail Address:

Employer:

Do you own or rent?
own     rent

If you rent, do you have the landlord's permission to keep a dog?
Yes   No   N/A

Landlord's Name:

Landlord's Phone Number:

How long at this address:

Is your yard fenced?
Yes   No

How many adults in the household?

How many children (with ages) in the household?

Who will be the primary caregiver for this dog (i.e. feeding, walking etc.)

How many consecutive hours per day are you away from home?

When nobody is home, where does your dog stay?
Select One In the yard In a crate In the garage In the house (but confined to areas) In the house (not confined to areas) In the house with doggie door In an outdoor run/pen

Rescue Prefences:

If interested in a certain pug on this web site, please specify by name(s):

Why do you want to adopt a pug? Please explain:

Are you willing to adopt a pug that would require daily medication (ie, eyedrops)?
Yes   No

Are you agreeable to returning the dog, should an unforeseen circumstance arise and you would no longer be able to keep the dog?

Would you be willing to allow us to visit your home prior to adoption?

Have you ever applied with another rescue organization? If so, which organization?

If your yard is not fenced, how do you plan to insure that the dog receives safe and adequate exercise?

Do you plan to keep the dog primarily indoors or out? Please explain

Pet History:

List All Pets You currently Own:

Dogs

Breed:     Age: 
Breed:     Age: 
Breed:     Age: 

Cats

Breed:     Age: 
Breed:     Age: 
Breed:     Age: 

How did you find out about us?

Please let us know anything else that would make you an ideal candidate for a rescue pug:

References:

List 3 references that can attest to your suitability and responsibility as a pet owner. If you own any pets now, please include your veterinarian as a reference.

***NOTE: 3 References Are REQUIRED***

Vet Reference (First if applicable)

Name:

Street:

City:

State:

Zip:

Phone:

Relation (if not vet):

Reference #2:

Street:

City:

State:

Zip:

Phone:

Relation (if not vet):

Reference #3:

Street:

City:

State:

Zip:

Phone:

Relation (if not vet):

Signature:

Date:

Thank you for your interest. This questionnaire helps us in placing the right dog with the right family. Improper placement can end tragically, most often for the dog.

Thank You!