PUG RESCUE OF SACRAMENTO (P.R.O.S.) P.O. Box 189455 Sacramento, CA 95818-9455 (916) 484-4158 E-mail: pugresq@aol.com Web address: http://pros.freeservers.com Please mail completed application to the above address or fax to (916) 446-0932 or (916) 428-8607. Incomplete applications may not be considered. If you have any questions, please call. ADOPTION APPLICATION Name:___________________________________Spouse/Partner:_____________________________ Address:_____________________________ City:______________________ State:____ Zip:_______ Phone: Home:___________________ Work:__________________ Spouse/Partner:______________ Age: ____ 20's, ____30's, ____40's, ____50's, ____60's, ____70's Spouse/Partner:_________ Employed by (Name & city)___________________________________ Hours worked per day:______ Occupation/Profession:_______________________Spouse's Occupation/Profession:______________ Spouse/Partner's employer:(Name & City) _______________________Hours worked per day:______ Names and ages of all other people living in the home:_______________________________________ __________________________________________________________________________________ Personal Reference (Name, address and phone number)______________________________________ __________________________________________________________________________________ Are you a United States citizen?____Yes ____ No Are you a full time student? _____Yes ____No How often do you travel on business?________________________ Pleasure?____________________ Do your animals travel with you? ____All of the time ____Sometimes ____ Rarely ____Not at all Is anyone in the home subject to transfer? ____Yes ____No How often?_______________________ Are you planning a move in the next year? ____Yes ____No When and to where?_______________ Do you live in a: ____ House ____Condo ____Apartment ____Mobile Home ____RV Park ____With parents/relatives ____Other:___________________________________________________ Does your Homeowners association, Apartment or Mobil Home allow pets? ____ Yes ____No If so, what size restrictions and what number of pets are allowed?______________________________ (Please attach the relevant portions of your lease or association agreement to this application) Do you: _______ Own? ______Rent? How long have you been at this address?________________ If less than 3 years, prior address?_______________________________________________________ Do you have an enclosed: ____Front Yard, ____Back Yard, ___Patio How tall are fences?________ Do you have a pool or spa? ____Yes ____No If yes, are they enclosed? ____ Yes ____No Do you have a balcony? ____Yes ____ No If yes, what is the space between the rails?___________ Will you reinforce or enclose areas if we request? ____ Yes ____No Will you put a lock on all gates? ___Yes ___ No Are all windows screened? ____Yes ____No Do you have any stairs? ____Inside ____Outside Are any stairs open backed? ____Yes ____No Pesticides, slug/snail pellets and other chemicals such as antifreeze are toxic and can kill animals. Do you agree not to use any of these in areas your pug can get to? ____ Yes ____No What pets do you currently own, and their breed, sex and age:_________________________________ __________________________________________________________________________________ Which ones are spayed/neutered?________________________________________________________ Are they current on immunizations? ___Yes ___ No On heartworm preventative? ___Yes ___No What pets have you had in the last 10 years that are not listed above?___________________________ __________________________________________________________________________________ What happened to them?______________________________________________________________ How long did you own each animal?_____________________________________________________ When did your last animal die or have to be euthanized?_____________________________________ Have you ever taken an animal to a shelter/pound? ____Yes ____No If yes, please explain:________ __________________________________________________________________________________ Have you ever had a pet euthanized? ___Yes ___No If yes, please explain:______________________ __________________________________________________________________________________ Who in the household wants the pug?____________________________________________________ Who will be responsible for its care?______________________________________________________ Have you ever owned a pug before? ___Yes ___No If not stated above, when?__________________ Where will you keep your pug during the day?______________________________________________ Where will your pug sleep at night?______________________________________________________ Where do other pets sleep?_____________________________________________________________ Will your pug be restricted from certain rooms of the house? ___Yes ___No If yes, which rooms?_____________________ Will you allow your pug on the furniture? ___Yes ___No How many hours a day, on average, will your pug be alone?___________________________________ Where will your pug stay when you are out of town?_________________________________________ Does anyone in the household smoke? ___Yes ___No If yes, how many people?_____________ Is anyone in your house allergic to animals? ___Yes ___No If yes, which person and to which animals?___________________________________________________________________________ How does your spouse/partner feel about dogs?_____________________________________________ Are you or your spouse/partner terminally ill? ___Yes ___No Can you deal with a pug who snores? ___Yes ___No With one who scratches? ___Yes ___No Who barks? ___Yes ___No Who has housebreaking accidents? ___Yes ___No Who licks? ___Yes ___No Who sheds a lot? ____ Yes ____No Have you ever housebroken a dog before? ___Yes ___No Did you use a crate? ____Yes ___No If a pug has a housebreaking accident, what should you do? ___Hit the dog and say "No", ___Lightly spank the dog and put them outside, ____Put the dogs nose in it and say "Bad Dog" ___All of the above ____Other (explain)________________________________________________ Do you agree to keep your pug current on all shots and on heartworm preventative? ____Yes ____No Do you authorize your veterinarian to allow us this information? ____Yes ____No Name/Phone of Vet:__________________________________________________________________ Have you ever adopted a dog from an animal shelter/pound or taken in a stray? ____Yes ____No Have you ever bred dogs? ____Yes ____ No If yes, when?___________________________ Why do you want a pug?_______________________________________________________________ __________________________________________________________________________________ Why do you want a rescue pug?_________________________________________________________ __________________________________________________________________________________ What type of pug do you want to adopt? (Check all that you are open to) Male_____ Female_____ No Preference ______ (All are spayed/neutered prior to adoption) Fawn_____ Black______ No Preference ______ Youngster/Teen (1-4 years)_____ Adult (5-7 years) ______ Senior (8+) _______ Active:_____ Mellow:_____ Special Needs:_____________________________________________ Are you open to possibly adopting a pug mix? ____Yes ____ No Is there anything specific you are looking for in a pug or pug mix?______________________________ __________________________________________________________________________________ Are you familiar with animal control regulations in your area? ____ Yes ____No Do you agree to keep a current ID tag on your pug at all times? ____ Yes ____No Do you have any problems with a representative of PROS calling periodically to check on how you and your pug are doing? ____ Yes ____ No Would you object to a home visit by a representative of PROS? ____ Yes ____ No If yes, why?_________________________________________________________________________ In case your pug had an emergency or serious illness, how much would you be willing to spend on vet bills? _____ $100 _____$250 _____$500 _____$1,000 _____ Whatever it takes? Under what circumstances would you justify getting rid of a dog?_________________________________ _____________________________________________________________________________________ How did you hear about PROS?__________________________________________________________ Thank you for taking the time to complete this questionnaire. Please try to answer each question as completely as possible. Incomplete applications may not be considered. By signing below, you are attesting to the truthfulness of your answers. Falsification of any of the above information will be grounds to disallow your adoption of a rescue pug. If there is any change in your living situation as documented in this application, PROS must be notified immediately. In the event a pug is adopted to a couple or family and the parties terminate their relationship or marriage in the future, PROS shall be informed and may assist in the determination of the party who shall keep the pug based on the best interests of the pug. PROS adopts only to homes willing to make a lifetime commitment to their pugs. Pugs are to be treated as family members. They require a quality diet and to be given regular medical care and vaccinations. PROS will be checking on the pug at various times and has the right to reclaim the pug if the circumstances warrant such action. Should an adopter ever have to give the pug up, it will be returned back to Pug Rescue of Sacramento at no charge to PROS. Rescue pugs cannot be euthanized without the prior notification and consent of an authorized representative of PROS unless the pug is in critical condition with no hope of survival in an extreme medical emergency. I HAVE READ AND AGREE TO ALL OF THE TERMS ABOVE: Signature of Applicant:_____________________________________________ Date:_______________ Signature of Spouse/Partner:________________________________________ Date:_______________ PROS RESERVES THE RIGHT TO REFUSE ANY ADOPTION 3