Pug's name *

Your Name *

Address

Street Address *

City

State

Country

Postal Code

Best Time to Call (copy) *

Email *

Best Time to Call *

Phone *

Date to Call *

Household Age Groups *

Does anyone in your house smoke indoors? *

Yes

No

Does either of your work require travel? If Yes, Frequency and Duration of Trips *

How does your Spouse/Partner feel about dogs? *

Type of Work You do *

Do you rent or own your home? *

Do you have an enclosed? *

Where do you live? *

Will you stop using toxins (pesticides, snail bait, Weed & Feed, antifreeze) in areas the Pug can get to? *

Yes

No

Are you will to reinforce enclosures if we deem it necessary to protect the Pug? *

Yes

No

What type of Pug do you wish to adopt? Be specific, so we can best match you to your Pug.(All PRSDC Pugs are neutered or spayed.) *

What other pets do you have now?(include all species) *

Are you allergic to any animals? *

Where, specifically, will the Pug sleep? *

Can you deal with a snoring pug? *

Will the Pug be allowed on the furniture? *

Will you accept a special needs Pug? *

Have you ever relinquished a pet? *

Have you lost a pet within the last 5 years? why? *

If your pug has a housebreaking accident, you should: *

Do you agree to keep your Pug current on all shots? *

Will you keep a current ID tag on your Pug at all times? *

Do you intend to get your Pug micro-chipped? *

Pug Rescue pays the medical bills for ALL FOSTERS, whether long or short-term. Pre-approval by the Adoptions Counselor or another Board Member is required for all vet visits. *In the case of a life-threatening emergency, take your foster Pug to the vet and call for approval from the vet's office.

Initial to confirm your understanding and agreement *

Personal Reference *

Address of the person *

Phone number of the person *

Your Vet *

Address of the Vet *

Phone number of the Vet *

I have read and agree to the terms above: *

Signature