Because Of You Chihuahua Rescue

 INSTRUCTIONS:

1.  Highlight the below Application Questions. Right Click>Copy.

2. Click to open an email to us. Because of You Chihuahua Rescue, Inc.

3. Right Click>Paste the questions into the open email.

4. Put your FULL name in the subject line where indicated.

5. Complete Your Answers.   Indicate check box choices by replacing with an X

6. Hit Send.

 Please Note that ALL questions must be answered before any application goes on to the Board of Directors.  If questions do not apply to you, please indicate that with an N/A.

Date:__________________________________

Chihuahua you are interested in: ____________________________

Name:_____________________________________ Spouses Name: _____________________________________

Address: __________________________________ City:______________ State: _________ Zip: _____________

Home Phone: ____________________ Cell Phone: ____________________ Work Phone: ___________________

Fax Number: _____________________ Email Address: __________________________________________________

Date of Birth: ____________________ Marital Status: _______________ Spouses D.O.B.: __________________

Occupation: __________________________________ Spouses Occupation: _______________________________

How long have you lived at this address? __________________ Ownership: (Mark one) ( ) Own  ( ) Rent

Type of Residence (Mark one)

( ) Apt/Condo  ( ) Townhouse  ( ) Mobile Home  ( ) Single Family  ( ) Farm

Setting (Mark one) ( ) Rural  ( ) Suburban  ( ) Urban

If renting, does the landlord allow dogs? ( ) Yes  ( ) No

*We need written permission from the landlord

Landlord(s) Name: _________________________________________________________

Landlord(s) Address: _______________________________________________________

Landlord(s) Phone: ________________________________________________________

Name, ages, and relationship of other adults in the home:

___________________________________________________________________________

___________________________________________________________________________

Names and ages of children living/visiting the home:

___________________________________________________________________________

___________________________________________________________________________

If you don't have children, are you planning on having children? ( ) Yes  ( ) No

Do you currently own any dogs? ( ) Yes  ( ) No       If so, how many? : __________________

Name(s), Breed, Sex:

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

How long have you had them? ____________________________________________________

Any previous dogs within the past 10 years? ( ) Yes  ( ) No

Please list them: _______________________________________________________________

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What happened to the pet(s)? (Mark one)

( ) Gave Away  ( ) Ran Away  ( ) Stolen  ( ) Hit by Car  ( ) Died  ( ) Other

If other, please explain: __________________________________________________________

_______________________________________________________________________________

Describe an average weekday in your home: __________________________________________

________________________________________________________________________________

What will your newly adopted pets living situation be like? (Mark one)

( ) Loose Indoors  ( ) Confined to 1 room  ( ) Crated Indoors  ( ) Crated outdoors  ( ) Loose in Fenced Area

( ) Tied/Chained Outdoors

How will you exercise? ( ) Leash Walks  ( ) Outdoors Kennel/Run ( ) Free Run in Fenced Yard

What do you consider reasonable routine vet expenses per year?

( ) Under 50  ( ) Under 100  ( ) Under 200  ( ) Under 300  ( ) Under 400  ( ) 400 and up

List the vet you currently use or have used in the past:___________________________

Veterinarians Address: _______________________________________________________

Veterinarians Phone: _________________________________________________________

Secondary Veterinarian? ______________________________________________________

Address: _____________________________ Phone: _______________________________

Do you use Heartworm preventative? ( ) Yes  ( ) No

Are your pets current on vaccinations? ( ) Yes  ( ) No

What temperament in an adopted dog will best suit your personality and lifestyle?

____________________________________________________________________________

____________________________________________________________________________

List name, phone and relationship of three friends or relatives:

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

<-----END OF APPLICATION----->

• Because of You Chihuahua Rescue, Inc.
• 16008 Deer Court                                                                                                                                 
• Edmond, Oklahoma 73013                                                                                                                           
• (405) 330-6464

Pet(s) Name: ______________________________Breed:______________________________

Color & Description:____________________________________________________________

Sex: _________________ Age: ___________________ Altered: ________________________

Remarks: _____________________________________________________________________________

Adopters Name: ________________________________ Phone: ________________________

Address: _____________________________________________________________________

City: __________________________________ State: __________________ Zip: _________

Drivers License Number: _______________________________________________________

AS THE ADOPTING PARTY, I AGREE TO THE FOLLOWIN PROVISIONS (initial by each)

1. _______I understand that Because of You Chihuahua Rescue, Inc. cannot guarantee the health, temperament or training of the above described animal, and hereby release Because of You Chihuahua Rescue, Inc. from all liability once the animal is in my possession. I understand that I am solely responsible for any future health care expenses. If a health problem develops during the first 10 days, I will notify Because of You Chihuahua Rescue to discuss the matter.
2. _______I understand that any animal could bite or hurt someone and once they are in my control, I am responsible.
3. _______I understand that only neutered or to-be-neutered animals are released for adoption from Because of You Chihuahua Rescue. therefore, if the above animal is not already neutered for medical reasons, I agree to have it neutered.
4. _______I agree to keep identification tag attached to a properly fitted collar at all times.
5. _______I agree to provide the adopted animal with the necessary inoculations at the intervals advised by my vet.
6. _______I agree to have a safe, secure fenced area for the dog, and the shelter from he elements. The adopted animal will not be tied or chained.
7. _______If for any reason I cannot keep the adopted pet, i agree to notify Because of You Chihuahua Rescue and return the animal to said rescue.
8. _______I agree not to abuse or neglect the adopted animal.
9. _______Adoption fees are non-refundable.

Signature of adopter_______________________________________________________

Date_____________________________________________________________________

Signature of "Because of You" representative___________________________________

Date_____________________________________________________________________