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PUG RESCUE OF MEMPHIS, INC.

ADOPTION APPLICATION

Personal Information

*Name *Email
*Address *City/State/Zip Code
*Home Phone Work Phone
Number of adults living in the household
   Number of children living in the household
         
Names of adults living in household
Age
   Names of children living in household
Age
 
 
 
 
         
      Are you expecting any children in the near future?
Pug Preferences
 (These preferences are treated as requests. We do not guarantee that the pug will meet all of your preferences)

Color:

Sex:

Age:
If you are interested in specific pug listed on the website, please enter the name here.
Current Pet Information
How many pets do you own currently?        
           
Type Breed
Spayed / Neutered?
Weight
Age
 General Disposition
Past Pet Information
How many pets have you previously owned?
(give information below)		    
       
Type Breed
How long did you own them?
Give a brief description of why you no longer own this pet.

Testing your family's knowledge about pugs:

Is everyone in your home aware of the following Pug characteristics?

Snoring Shedding
Snorting Lap Dog(Couch Potato)
Overheat easily Highly susceptible to eye injuries

List any other pug characteristics that you know of.

*Does anyone in the household have objections to any of the above?

*Does everyone agree on having a Pug after reading information about the breed?
Questions about your living arrangements
*What type of dwelling do you live in?
*Do you own or rent?
If you rent, do you have permission from your landlord to have a dog?
*How many years have you lived at the address provided?
*Do you plan on moving in the near future?
*Do you have a completely, escape-safe, fenced in yard?

If yes, what type of fence is it?
How many gates?
Do you own a pool?

If yes, is it fenced or screened in (separately from the yard)?
*How do you plan to insure your pet's safety while it is outdoors?
Do you allow your current pets on the furniture?
Will you allow a rescue pug on the furniture?
Where do you plan for your pug to sleep?
Questions about pug ownership & the adoption process
*Why do you want to own a Pug?
*Would you be willing to allow us to visit your home prior to adoption?
Have you applied with another rescue organization(s)?

If yes, which organization(s)?

Would you consider adopting a special needs pug?

If yes, list all types of special needs you feel you are prepared to handle. (For example: blind, deaf, can't walk, serious medical attention required, etc.)
*How much time will you allow for you and your new Pug to adjust to each other? (Total over all time and approximate hours per day on weekdays and weekends)
*How do you plan on making this adjustment? (What kind of things do you plan to do, to make your new pug feel like it's part of the family?)
*What will you do if you encounter possible behavioral problems with your Pug? (relieving itself indoors, barking too much, chewing, demanding a lot of attention)
*Are you agreeable to returning the dog, should an unforeseen circumstance arise wherein you would no longer be able to keep the dog?
What circumstances, in your mind, justify giving a dog up? (Check all that apply)

Moving Children lose interest
New baby Divorce
Not getting along with current pets Behavioral problems
Escaping from fenced in yard If it gets too big / overweight
Shedding Housebreaking problems
Medical problems Allergies
Too time consuming
Aggressive behavior Cannot think of any reason to give up a pug
*How many hours a day are you gone from your home? (for work or other commitments)
How many hours a day would your pug be in a crate if you choose to use one?
*Will you be hiring a pet sitter or have a neighbor check on your pug periodically if you plan to be gone a long time, over 8 hours, during the day?
*What will you do with your Pug if no one is at home during the day? (For example: Let it roam free?, leave it free but restrict access to certain rooms?, keep it in a crate, lock in a specific room like the kitchen or bathroom?)
*What will you do with your Pug while on vacation? (For example: Kennel it, leave it with a neighbor or family member, etc.)

*What will you do with your Pug if you have to move? (For example: Take it with you?, Give it to a friend, Give it to a family member, give it up for adoption to a rescue organization, leave it at the animal shelter, etc)
*List the medical care that will be provided (regular visits, emergency care, etc.)
How much do you think this medical care will cost? How much are you willing to invest in keeping your pug healthy?
*What type of heartworm preventative do you plan on using for your new pug?
*What type of flea & tick preventative do you plan on using for your new pug?
*What will you do if your Pug requires expensive medical care?
*What will you do if your Pug is lost or stolen?
What method of ID do you plan on using for your pug? (Check all that apply) ID Tag w/Current phone #, Embedded chip
Please provide information about the regular Vet/Clinic you use or plan to use
*Name Vet(s)
Address City/State/Zip Code
*Phone    
Please provide information about the 24 hr EMERGENCY Clinic you use or plan to use
It is vital to us that you know where your local emergency animal clinic is, please take the time to find out before submitting this application. Call your vet for information if you are having problems locating a 24 hour emergency clinic in your area.
*Name Vet(s)
*Address City/State/Zip Code
*Phone    
Comments
Is there anything else you'd like us to consider that we failed to ask?
Personal References
*Name *Phone Number (with area code) Relationship
* *
* *
* *
A Brief Survey
How did you hear about Pug Rescue of Memphis?

Fields with a red '*' are required.