Pacific Pug Rescue Adoption Application
To help ensure the best possible placement for our rescued dogs, and in order to determine that the proposed adoption is in the best interest of both the dog, you and your family, please complete the following. Please be as thorough as possible. Only completed applications are eligible for review. Mail completed application & $10 Adoption Application Donation to Pacific Pug Rescue P.O. Box 820032 Portland, OR 97282-1032
Full Name:
Phone Number:
E-Mail:
Spouse/Partner:
Co-Applicant Phone Number:
Co-Applicant E-Mail:
Current Address:
How long at this address?
Names and ages of all members of your household (including yourself):
Employer:
How Long Employed:
Work Phone:
Spouse/Partner Employer
Work Phone:
Rent or Own:
If you rent, can you supply written permission to have a dog from your landlord? Please provide:
Landlord's Name:
Landlord’s Phone:
Pet History
Have you owned a dog before?
If so, what breed/breeds?
Please list your regular Veterinarian/Vet Clinic:
Veterinarian Phone:
Do any household members suffer from “pet” allergies?
List all pets currently residing in your home and their ages:
Are all pets up to date on vaccines?
Are they spayed or neutered?
If not spayed or neutered, why not?
Do any of your animals have any physical problems?
Do your animals get along with other dogs/Cats and other animals?
Will the pug have any exposure to children?
Why do you want to adopt a Pug?
What are the characteristics you are looking for in a Pug?
What is your preference regarding the following?
Sex:
Color:
Age:
Will you consider something other than your stated preference?
Are you willing to house train a Pug?
Can you deal with a Pug that may bark?
Where will you keep the dog:
During the day?
At night?
If you are away from home overnight?
Do you have a fenced yard?
Kind of fencing and height?
If you do not have a fenced yard, how will you:
Exercise the dog?
Provide for their need to eliminate?
Have you ever surrendered to an animal shelter or sold any of your pets?
If yes, please explain the circumstances:
What circumstances do you feel justify giving up a pet?
Are you able to spend at least $1,000.00 per year for food and routine medical care for your pet?
Has anyone in your immediate family/household ever been convicted of a charge related to cruelty to animals or child abuse?
Please provide the names, email addresses, and phone numbers of two non-related individuals who can serve as references:
Reference #1
Full Name:
E-mail:
Phone Number:
Reference #2
Full Name:
E-mail:
Phone Number:
What will you do with your dog if you move?
What do you and your home environment have to offer a Pug that has been neglected/abandoned?
Thank you for taking your time to complete this application. By signing below you attest to the truthfulness of your answers. Falsification of any of the above information will be grounds to disallow your adoption of a rescued pug.
If there are two responsible adults in household, both must sign as an applicant.
Applicant Signature: ______
Applicant Signature: ______