Why do you want a rescue pug? 001
As the main person filling out this application, are you the primary care person? 002
Yes No
Are you physically able to take care of the pug? 003
Yes No
Are you able to lift a 20 pound animal? 004
Yes No
Are you a United States Citizen? 005
Yes No
Are you a year round CA resident? 006
Yes No
Does anyone in the home smoke? 007
Yes No
Do you have changing roommates? 008
Yes No
Do you want a pug to give as a gift? 009
Yes No
Is anyone in the home terminally ill? 010
Yes No
Do you rent or own? 011
Rent Own
What type of residence do you live in (ie. house, condo, apartment, mobile home, etc.)? 012
Do you live on/near open water? 013
Yes No
Is anyone in home (over 18) not able to take care of the pug? 014
Yes No
Have any of the applicants ever been cited or fined for animal related situations? 015
Yes No
Have you been denied adoption from another rescue group or shelter? 016
Yes No
Is anyone in your household allergic to dogs? 017
Yes No
Does anyone in the home not want the pug? 018
Yes No
If Yes, explain.
Do you travel on business? 019
Yes No
If Yes, how often?
Do you travel for pleasure? 020
Yes No
If Yes, how often?
Do your animals travel with you? 021
Yes No
If Yes, how often?
Does anyone in your family work from home? 022
Yes No
Is anyone in the home subject to transfer? 023
Yes No
If Yes, how often?
Will you have any major lifestyle changes in the near future? (ie. expecting child, moving, etc.) 024
Yes No
If Yes, explain.
Have you ever owned a pug before? 025
Yes No
Have you ever lived with a pug before? 026
Yes No
Have you ever lived with a dog before? 027
Yes No
Do you currently own a dog? 028
Yes No
If Yes, how many?
Describe each.
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
Yes No
If Yes, explain.
Do you have a cat or cats? 031
Yes No
If Yes, how many?
Are they dog friendly?
Yes No I don't have any.
Have you ever lost an animal? 032
Yes No
If Yes, was the animal found?
Yes No Never lost
Have you ever taken an animal to a shelter or released an animal to another party? 033
Yes No
If Yes, explain.
Have you ever bred animals for pleasure or profit? 034
Yes No
Are you familiar with the animal control regulations in your area? 035
Yes No
Are all of your current household animals spayed or neutered? 036
Yes No
Are all of your household animals current on vaccinations? 037
Yes No
What type of pug do you prefer? Check all that apply. 038
Fawn Black Brindle No Color Preference Male Female No Gender Preference 1-4 yr 5-8 yr 9+ yr No Age Preference Special Needs
Would you adopt a special needs pug? 039
Yes No
If open to special needs, please check which special need(s) you would accept. Check all that apply.
Blind Deaf Diabetic Epileptic Arthritis Allergies Daily Medications Incontinent Can't climb stairs Back Problems
Are you open to adopting a pug mix? 040
Yes No
Is there anything else specific you are looking for in a pug? 041
After you adopt, would you be willing to foster? 042
Yes No
Would you like to foster until you've found the right pug for your family? 043
Yes No
Can you deal with a pug that snores? 044
Yes No
Can you deal with a pug that scratches to communicate? 045
Yes No
Can you deal with a pug that may bark? 046
Yes No
Can you deal with a pug that has accidents or may become incontinent? 047
Yes No
Can you deal with a pug that licks? 048
Yes No
Can you deal with a pug that sheds a lot? 049
Yes No
Are you willing to house train a new pug? 050
Yes No
Are you willing to trim the nails or have the pugs nails trimmed on a regular basis? 051
Yes No
Are you willing to administer daily eye drops or medicine to the pug if needed? 052
Yes No
Are you willing to have the pugs anal gland expressed periodically if needed? 053
Yes No
Have you ever housebroken a dog before? 054
Yes No
Did you use a crate? 055
Yes No
Will the pug be restricted from/to certain room(s)? 056
Yes No
If Yes, explain.
Will the pug be restricted from the furniture? 057
Yes No
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
Yes No
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
Yes No
Do you agree to keep your pug current on all shots and on heartworm preventative? 066
Yes No
Can you commit to care for the pug for its whole life, even if special needs arise? 067
Yes No
What would you do if your pug became a special needs pug? 068
Do you have and use air conditioning? 069
Yes No
Do you have a pool or spa? 070
Yes No
If Yes, is the pool covered or fenced?
Yes No I don't have a pool.
Do you have a backyard? 071
Yes No
If Yes, is it fenced?
Yes No I don't have a backyard.
Do you have a fenced front yard? 072
Yes No
Do you have a fenced patio? 073
Yes No
How tall are your fences in front yard &/or backyard? 074
Do you have a gate to the backyard? 075
Yes No I don't have a backyard.
If utility meters are located in backyard area, will meter readers be entering this area? 076
Yes No N/A
Will gardeners or pool maintenance people be entering the back area? 077
Yes No
Are you willing to put a padlock on the back area gate? 078
Yes No
Do you have a balcony or deck? 079
Yes No
If Yes, what is the space between rails (inches)?
Do you have stairs? 080
Yes No
If Yes, do you have stairs inside, outside or both?
Inside Outside Both Inside and Outside N/A
If you have stairs, are any stairs open backed?
Yes No N/A
Will you reinforce or enclose areas if we request? 081
Yes No
Are all windows screened? 082
Yes No
Do you have a doggy door? 083
Yes No
If No, are you planning to get a doggy door?
Yes No I 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
Yes No
Does your homeowners association, apartment, or mobil home, condominium, etc. allow pets? 085
Yes No N/A
If Yes, explain restrictions.
If you rent, do you have permission to own a dog? 086
Yes No N/A
Your Landlord's Information:
Name:
If your pug had an emergency or serious illness, how much would you be willing to spend on vet bills? 087
$100 $250 $500 $1000 Whatever 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
Yes No
Would you object to a home visit by a representative of PRNC? 090
Yes No
If Yes, why?
Are you willing to return the pug to PRNC should unforeseen circumstances arise? 091
Yes No
Do you authorize your veterinarian to give PRNC a reference? 092
Yes No
If Yes.
Current Vet:
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.
ADOPTION APPLICATION FORM
