Pug Lovers Rescue Adoption Application

Please specify which Pug/English Bulldog on our website you might be interested in adopting. Put N/A if no preference. *
Your Full Name [First & Last] *

Your full name please
Email *

Your email please
Full Address, Street, City, State & Zip *

Put Your Full Mailing Address [Street, City, State, Zip Code]
Home, Work & Cell Phone in that order *

Home, Work & Cell Phone in that order
Your Occupation & years you have worked there *

Your Occupation & years you have worked there
Hours Worked *

Hours Worked
Employers Name & Phone number *

Employers Name & Phone number
If less than 2 years employed, previous job *

If less than 2 years employed, previous job
Applying to Pug Lovers Rescue for *

Applying to Pug Lovers Rescue for
Landlord's Name, Phone & Address *

Landlord's Name, Phone & Address
Which of the following best describes your current residence? *

Which of the following best describes your current residence?
If you rent, are pets permitted in your lease? Indicate weight if applicable:

If you rent, are pets permitted in your lease? Indicate weight if applicable:
How is your yard secured (is it fenced ect...)? If it is fenced what kind of fence do you have? *

How is your yard secured (is it fenced ect...)? If it is fenced what kind of fence do you have?
Do you have a Pool? * Yes, I have a pool - it is not fenced, though Yes, I have a pool - with a security fence around it No Pool
Do you have a Pool?
Do you have a doggy door? * Yes No
Do you have a doggy door?
How many adults in your home including you? Please List All Of Them *

How many adults in your home including you? Please List All Of Them
Please list the children living with you (by ages) *

Please list the children living with you (by ages)
If you do not have children now, are you considering starting a family in the future?

If you do not have children now, are you considering starting a family in the future
Your Age, Your Spouses Age? *
Do you plan on moving in the next 6 months? * Yes No
Do you plan on moving in the next 6 months?
Would the dog go with you? * Yes No
Please list all current & previous pets in this format: 1. Name, 2. What kind of pet, 3. Sex, 4. Spayed or neutered, 5. Age 6. Where is it housed (inside, outside, both), 7. Where is it now? If it is deceased please explain what happened. Please be as detailed and truthful as possible. If you have never had a pet just put N/A. *
Please list any specific characteristics that you want to see in your new dog - lap dog vs. hyper, love sponge vs. independent, etc... *

Please list any specific characteristics that you want to see in your new dog - lap dog vs. hyper, love sponge vs. independent, etc...
Who will be responsible for this Dog? *

Who will be responsible for this Dog?
How many hours a day will this Dog be alone? Where will it be kept at night?

How many hours a day will this Dog be alone? Where will it be kept at night?
Where will the dog stay during the day? *

Where will the dog stay during the day?
Is anyone in the household allergic? * Yes No
Is anyone in the household allergic?
Would you adopt a special needs dog/puppy? (ie. blind, timid, 3 legged, daily medication)? * Yes No
Would you adopt a special needs dog/puppy? (ie. blind, timid, 3 legged, daily medication)?
Why are you interested in getting a Dog at this time? *

Why are you interested in getting a Dog at this time?
All of these dogs need a refresher course in housebreaking. How will you housebreak your dog? *

All of these dogs need a refresher course in housebreaking. How will you housebreak your dog?
What would happen if your dog got very sick and you were looking at spending thousands of dollars to cure the illness? *

What would happen if your dog got very sick and you were looking at spending thousands of dollars to cure the illness?
Have you ever given up a pet in the past? If so please explain why. *

Have you ever given up a pet in the past? If so please explain why.
What would make you consider giving up your Dog: (check all that apply) * Accidents in the house Problems with another pet Moving Divorce New baby (afraid dog might bite) Aggression toward anyone Other, please specify below
What would make you consider giving up your Dog: (check all that apply)
Other reasons I would consider giving up my Dog are

Other reasons I would consider giving up my Dog are
What would happen to this Dog if family situation changed (divorce, relocation, death)? Please answer this question in detail. *

What would happen to this Dog if family situation changed (divorce, relocation, death)? Please answer this question in detail.
Have you ever given away/sold or released an animal to a shelter or rescue group? If yes, why? *

Have you ever given away/sold or released an animal to a shelter or rescue group? If yes, why?
Have you ever been denied adoption by a shelter or other rescue or humane group? If yes, by whom? *

Have you ever been denied adoption by a shelter or other rescue or humane group? If yes, by whom?
Vet's Name, Phone & Address (we need all 3, apps not giving all will be discarded), if you don't have one please explain. *

Vet's Name, Phone & Address (we need all 3, apps not giving all will be discarded), if you don't have one please explain.
Please give three references. These may be friends, co-workers and relatives. Please give their name Relationship to you Email address Phone number *

Please give three references. These may be friends, co-workers and relatives. Please give their name Relationship to you Email address Phone number
Any additional comments or information you would like to include.
Your Signature & Date, by signing, this signifies you agree this is a legal and binding contract between Pug Lovers Rescue & You. *

Your Signature & Date, this signifies you agree this is a legal and binding contract between Pug Lovers Rescue & You.
Type the letters you see in the image below.

This field is NOT case sensitive, please type the letters you see on the left in the box below.