Pug Name(s) *

Your Name *

Spouse/Partner/Roommate

Address

Street Address *

City

State

Country

Postal Code

Home Phone Number

Work Phone Number

Cell Phone Number

Email Address *

Best Time to Call *

Which number to call?

Date to Call

Household Age Groups. Please state

Spouse/Partner Household Age Groups. Please state

Other adult(s) living at home. Please state

Child(ren) living at home

Does anyone in your house smoke indoors? Yes or No

How does your Spouse/Partner feel about dogs? *

Type of Work You do *

Partner's Work

Does either of your work require travel? *

If Yes, Frequency and Duration of Trips

Describe the place

Is someone home during the day?

Where will the Pug stay during the day?

How many hours a day will the Pug be left alone? Please specify.

Length of time at This address mentioned.

Are you moving within a year? Yes or No

Do you rent or own your home? *

Where do you live? *

Do you have a Homeowner's Association?

Do you have an enclosed Front Yard or Back Yard? *

Describe your yard

Do you have an enclosed pool or spa?

Pugs can't swim, Describe:

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

Will you stop using toxins (pesticides, snail bait, Weed & Feed, antifreeze) in areas the Pug can get to? Yes or No

Do you have a Gardener? Yes or No

Do you have a house Cleaner?Yes or 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? If Yes, Explain. *

Where, specifically, will the Pug sleep? *

Can you deal with a snoring pug? *

Will the Pug be allowed on the furniture? *

Will you deal with housebreaking?

Will you accept a special needs Pug? *

Would you ever leave your Pug in a car? *

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: Specify

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? *

Pugs, like any other pet, require a top quality diet and routine veterinary checkups as well as regular dental care. In addition to their annual shots and other routine exams, there is always the possibility of illness or emergency care and its accompanying expenses. Will you commit to this financial responsibility? To adopt a Pug from Pug Rescue of San Diego County (PRSDC), adopters must have an extremely high level of commitment to their dog. It is a responsibility for the life of the dog, whether sick or well, young or elderly. The average life span of a Pug may be 12-15 years. Pugs are to be treated as family members throughout their lives. A volunteer from PRSDC may check back with you once or twice after the adoption. Should conditions ever be substantially different than the Adopter has represented, PRSDC reserves the right to reclaim the Pug if they feel it is in the Pug's best interest. Should an Adopter ever have to give up a Pug, unless prior arrangements have been made with PRSDC, ownership will automatically revert to, and the Pug must be returned to, PRSDC. ADOPTION FEES USUALLY RANGE FROM $100 - $800, DEPENDING ON AGE, HEALTH AND PERSONALITY OF THE PUG.

Initial to confirm your understanding and agreement *

Personal Reference *

Address of the person *

Phone number of the person *

Your veterinarian *

Address of the veterinarian *

Phone number of the veterinarian *

I have read and agree to the terms above mentioned: *