Adoption Application

If you wish to be considered for Adoptions then we need you to please complete the form below. Your details will not be released to any other organizations or individuals other than the board members of PugHearts of Houston.

We take all adoption requests very seriously and as such we may ask you further questions to validate your responses on this form.

!! READ THIS FIRST !!

Before you complete this form, please read, absorb and think about all the information on the Pugs page. We ask you to do this because we believe that too many people apply for adoption before doing enough research about the Pug breed. If you are still sure that you want to help a Pug, then complete the application form and we will process it as quickly as possible.

There is an adoption fee of $250 ($300 for puppies) to be paid if you are successful in the adoption process.

This is a lengthy form and we thank you for your cooperation. We ask that you be detailed as opposed to brief. Applications with short, or one word answers do not help us when processing the information and will most likely be rejected. This comprehensive questionnaire helps us in placing the right dog with the right family. An improper placement or one which all the details are not known can end tragically, usually for the dog.

We receive a large amount of applications each week and we only have a limited amount of volunteers to process them, so please ensure that you complete each and every section. FAILURE to do so will almost certainly delay processing of your application and ultimately result in it being rejected.

WHICH DOG(S) ARE YOU INTERESTED IN ADOPTING ?

Part A - Personal Information

First		Last
Address
Address
City		State
Zip		Daytime Phone
Evening Phone		Mobile Phone
Email Address

Residents of your Household

Adults over 18 Years	Children 0-12 Years	Children 12-18 Years

Type of Dwelling

Is you own or rent ? Rent Own
House	Apartment	Trailer
Condo/Townhouse	Duplex/Triple	Other

If you selected Other then please explain more about your dwelling

Rented Accommodation (Rented Only)

Do you have your landlords permission to keep a dog? Yes No

Landlord Information (Rented Only)

First		Last
Address
Address
City		State
Zip		Daytime Phone
Evening Phone		Mobile Phone
Email Address

What are your ideal rescue requirements ?

Color Preference	Age Preference	Sex Preference
No Preference Fawn Black	No Preference Puppy (6mo - 1 Yr) 1-4 Years 4-8 Years Senior	No Preference Male Female
Are you agreeable to returning the dog, should unforeseen circumstances arise wherein you would not longer be able to keep the dog? Yes / No
Would you be willing to allow us to visit your home? Yes / No
If out of state, will you make provisions to pick up the pug? We do NOT ship dogs. Yes / No
Have you applied to another rescue group? Yes / No

Part B - Environment Information

Where do you intend for the dog to sleep?

Do you have a yard suitable for the a dog? Yes / No

Is the yard securely fenced? Yes / No

If you specified that you do not have a yard suitable for a dog. Can you explain your plans to insure that the dog receives safe and adequate exercise?

If you specified that your yard is not fenced. Can you explain your plans to insure that the dog receives safe and adequate exercise?

What kind of fence do you have and how tall is the fence?

Part C - Your Current and Previous Pet History

Do you currently own or have ever owned a dog? Currently / Previously / No

Do you currently own or care for a other types of animal? Yes / No

Please give details of the animals you own or currently care for.
Animal & Breed	Name & Age	Spayed or Neutered	Stay Indoors or Outdoors
		No Yes	Indoors Outdoors
		No Yes	Indoors Outdoors
		No Yes	Indoors Outdoors
		No Yes	Indoors Outdoors
		No Yes	Indoors Outdoors
		No Yes	Indoors Outdoors
		No Yes	Indoors Outdoors
		No Yes	Indoors Outdoors

Have you ever had to give up a pet? Yes No

If you selected YES, can you please explain more about the pet you gave up?

If you have stated that you currently own a dog, or have in the
past owned a dog, then please complete the following.

Where did you get this dog(s) ?

What activities do you participate in with your dog(s) ?

Have you attended obedience classes with your dog(s) ?

What type of Heartworm Preventative do you give your dog(s) ?

What type of flea control do you use on your dog(s) ?

What to you feed your dog(s) (brand/type) ?

When nobody is home, where does your dog(s) stay ?

In the yard   / In a crate   / In the garage In the house confined to an area   / In the house not confined to an area In the house with a doggie door   / In an outdoor run/pen

Is your dog(s) neutered ? Yes No

If you answered NO can you please explain why ?

Part D - Training and Obedience

Are you likely to enroll your dog in obedience class ? Yes No

Which family members would be expected to assist in home training ?

Part E - Your Knowledge of Pugs

Are you aware of pugs health problems ? Yes No

If you answered YES could you please expand on what you know about pug health problems ?

Are you aware that pugs shed 365 days a year ? Yes No

Did you know that pugs snore and expel a large amount of gas ? Yes No

Pugs are companion animals, they will want to be with you constantly. Pugs were bred solely for companionship.   Are you prepared for this ? Yes No

Pugs can live upwards of 14 years. Are you committed to care for it that long ? Yes No

How did you find out about us ?

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

Part F - Your Personal and Veterinary References

Please supply us with the details of a vet practice you are registered with.

We also require that you please list TWO references that can attest to your suitability as a
pet owner, and more specifically, the owner of a rescued dog.

We require Full Name, Address, City, State, Zip and Phone Numbers

Please note, failure to supply this information will cause your adoption
application to be placed on hold until the information is provided.

WE DO CHECK ALL REFERENCES

Vet Information

Reference A

Reference B

Part G - Your Declaration and Digital Signature

I, the undersigned, attest that, to the best of my knowledge, the above information is accurate and complete at the time of signing. I understand that falsely provided information will mean that my application is terminated.

Signature

Date