ADOPTION APPLICATION FORMADOPTION APPLICATION FORM

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    Your General Information
















    Age*
    20's30's40's50's60's70's

    Spouse / Partner / Roommate









    Age
    20's30's40's50's60's70'sN/A

    Questions

    Why do you want a rescue pug? 001
    As the main person filling out this application, are you the primary care person? 002
    YesNo
    Are you physically able to take care of the pug? 003
    YesNo
    Are you able to lift a 20 pound animal? 004
    YesNo
    Are you a United States Citizen? 005
    YesNo
    Are you a year round CA resident? 006
    YesNo
    Does anyone in the home smoke? 007
    YesNo
    Do you have changing roommates? 008
    YesNo
    Do you want a pug to give as a gift? 009
    YesNo
    Is anyone in the home terminally ill? 010
    YesNo
    Do you rent or own? 011
    RentOwn
    What type of residence do you live in (ie. house, condo, apartment, mobile home, etc.)? 012
    Do you live on/near open water? 013
    YesNo
    Is anyone in home (over 18) not able to take care of the pug? 014
    YesNo
    Have any of the applicants ever been cited or fined for animal related situations? 015
    YesNo
    Have you been denied adoption from another rescue group or shelter? 016
    YesNo
    Is anyone in your household allergic to dogs? 017
    YesNo
    Does anyone in the home not want the pug? 018
    YesNo
    If Yes, explain.
    Do you travel on business? 019
    YesNo
    If Yes, how often?
    Do you travel for pleasure? 020
    YesNo
    If Yes, how often?
    Do your animals travel with you? 021
    YesNo
    If Yes, how often?
    Does anyone in your family work from home? 022
    YesNo
    Is anyone in the home subject to transfer? 023
    YesNo
    If Yes, how often?
    Will you have any major lifestyle changes in the near future? (ie. expecting child, moving, etc.) 024
    YesNo
    If Yes, explain.
    Have you ever owned a pug before? 025
    YesNo
    Have you ever lived with a pug before? 026
    YesNo
    Have you ever lived with a dog before? 027
    YesNo
    Do you currently own a dog? 028
    YesNo
    If Yes, how many?
    Describe each.
    1 Breed
    Age
    Character ActiveMellowAlphaDon't have one.
    Gender MFDon't have one.
    2 Breed
    Age
    Character ActiveMellowAlphaDon't have one.
    Gender MFDon't have one.
    3 Breed
    Age
    Character ActiveMellowAlphaDon't have one.
    Gender MFDon't have one.
    4 Breed
    Age
    Character ActiveMellowAlphaDon't have one.
    Gender MFDon't have one.
    Do any of your dogs have any physical problems?
    Do any of your dogs have dominance problems?
    Do any of your dogs not get along with other dogs?
    What other pets did you have in the last 10 years? 029
    What happened to them?
    How long did you own each animal?
    Have you ever had an animal euthanized? 030
    YesNo
    If Yes, explain.
    Do you have a cat or cats? 031
    YesNo
    If Yes, how many?
    Are they dog friendly?
    YesNoI don't have any.
    Have you ever lost an animal? 032
    YesNo
    If Yes, was the animal found?
    YesNoNever lost
    Have you ever taken an animal to a shelter or released an animal to another party? 033
    YesNo
    If Yes, explain.
    Have you ever bred animals for pleasure or profit? 034
    YesNo
    Are you familiar with the animal control regulations in your area? 035
    YesNo
    Are all of your current household animals spayed or neutered? 036
    YesNo
    Are all of your household animals current on vaccinations? 037
    YesNo
    What type of pug do you prefer?  Check all that apply. 038
    FawnBlackBrindleNo Color PreferenceMaleFemaleNo Gender Preference1-4 yr5-8 yr9+ yrNo Age PreferenceSpecial Needs
    Would you adopt a special needs pug? 039
    YesNo
    If open to special needs, please check which special need(s) you would accept.  Check all that apply.
    BlindDeafDiabeticEpilepticArthritisAllergiesDaily MedicationsIncontinentCan't climb stairsBack Problems
    Are you open to adopting a pug mix? 040
    YesNo
    Is there anything else specific you are looking for in a pug? 041
    After you adopt, would you be willing to foster? 042
    YesNo
    Would you like to foster until you've found the right pug for your family? 043
    YesNo
    Can you deal with a pug that snores? 044
    YesNo
    Can you deal with a pug that scratches to communicate? 045
    YesNo
    Can you deal with a pug that may bark? 046
    YesNo
    Can you deal with a pug that has accidents or may become incontinent? 047
    YesNo
    Can you deal with a pug that licks? 048
    YesNo
    Can you deal with a pug that sheds a lot? 049
    YesNo
    Are you willing to house train a new pug? 050
    YesNo
    Are you willing to trim the nails or have the pugs nails trimmed on a regular basis? 051
    YesNo
    Are you willing to administer daily eye drops or medicine to the pug if needed? 052
    YesNo
    Are you willing to have the pugs anal gland expressed periodically if needed? 053
    YesNo
    Have you ever housebroken a dog before? 054
    YesNo
    Did you use a crate? 055
    YesNo
    Will the pug be restricted from/to certain room(s)? 056
    YesNo
    If Yes, explain.
    Will the pug be restricted from the furniture? 057
    YesNo
    Where will the pug sleep at night? 058
    Where do other animals sleep? 059
    How many hours a day, on average, will your pug be alone? 060
    Where will you keep your pug when you are away from home during the day? 061
    While you are out, will the pug have access to a doggy door and the outdoors? 062
    YesNo
    Where will your pug stay when you are out of town? 063
    If the pug has an accident in the house, explain what you would do? 064
    Do you agree to keep a current ID tag on your pug at all times? 065
    YesNo
    Do you agree to keep your pug current on all shots and on heartworm preventative? 066
    YesNo
    Can you commit to care for the pug for its whole life, even if special needs arise? 067
    YesNo
    What would you do if your pug became a special needs pug? 068
    Do you have and use air conditioning? 069
    YesNo
    Do you have a pool or spa? 070
    YesNo
    If Yes, is the pool covered or fenced?
    YesNoI don't have a pool.
    Do you have a backyard? 071
    YesNo
    If Yes, is it fenced?
    YesNoI don't have a backyard.
    Do you have a fenced front yard? 072
    YesNo
    Do you have a fenced patio? 073
    YesNo
    How tall are your fences in front yard &/or backyard? 074
    Do you have a gate to the backyard? 075
    YesNoI don't have a backyard.
    If utility meters are located in backyard area, will meter readers be entering this area? 076
    YesNoN/A
    Will gardeners or pool maintenance people be entering the back area? 077
    YesNo
    Are you willing to put a padlock on the back area gate? 078
    YesNo
    Do you have a balcony or deck? 079
    YesNo
    If Yes, what is the space between rails (inches)?
    Do you have stairs? 080
    YesNo
    If Yes, do you have stairs inside, outside or both?
    InsideOutsideBoth Inside and OutsideN/A
    If you have stairs, are any stairs open backed?
    YesNoN/A
    Will you reinforce or enclose areas if we request? 081
    YesNo
    Are all windows screened? 082
    YesNo
    Do you have a doggy door? 083
    YesNo
    If No, are you planning to get a doggy door?
    YesNoI already have a doggy door.
    Pesticides, slug/snail pellets and other chemicals such as antifreeze are toxic.  Do you agree not to use any of these in areas your pug will have access to? 084
    YesNo
    Does your homeowners association, apartment, or mobil home, condominium, etc. allow pets? 085
    YesNoN/A
    If Yes, explain restrictions.
    If you rent, do you have permission to own a dog? 086
    YesNoN/A
    Your Landlord's Information:
    Name:
    Phone:
    If your pug had an emergency or serious illness, how much would you be willing to spend on vet bills? 087
    $100$250$500$1000Whatever it takes
    Under what circumstances would you justify getting rid of a pug? 088
    Would you object to a representative of PRNC calling to check on how you & pug are doing? 089
    YesNo
    Would you object to a home visit by a representative of PRNC? 090
    YesNo
    If Yes, why?
    Are you willing to return the pug to PRNC should unforeseen circumstances arise? 091
    YesNo
    Do you authorize your veterinarian to give PRNC a reference? 092
    YesNo
    If Yes.
    Current Vet:
    Phone:
    How did you find out about PRNC? 093
    Is there anything else you think we should know about you, your pets or your family? 094

    Terms of Agreement

    Thank you for taking the time and care to complete this application.  Please try to answer each question as completely as possible.  Incomplete applications may not be considered.  By clicking “SUBMIT THE APPLICATION” button 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.

    Our rescue pugs are located throughout the Northern California area.  In order to be considered for a particular pug, you must be willing to drive to where that pug is being fostered.  By submitting this application, you attest that you will travel to meet a pug when a possible match has been determined.  Refusal to travel to meet a pug due to distance only will terminate the entire adoption process with Pug Rescue of Northern California (PRNC).

    PRNC adopts pugs 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, to be given regular medical care and vaccinations.  PRNC will be checking on the pug at various times and has the right to reclaim any pug if the circumstances warrant such action.  Should an adopter ever have to give up the pug, it will be returned back to PRNC at no charge to PRNC.

    PUG RESCUE OF NORTHERN CALIFORNIA RESERVES THE RIGHT TO REFUSE ANY ADOPTION.

    I HAVE READ AND AGREE TO ALL OF THE TERMS ABOVE, ADDITIONALLY I HAVE READ AND UNDERSTAND THE “ADOPTION PROCESS”.