Yorkie Friends Rescue Corporation
Application for Adoption
Personal Information
List the particular dog in which you are interested
Last Name First, First Name Last
Age
Spouse's Name
 Age
Address
City
State
 Zip
E-mail Address
Home Phone
 Cell Phone
Employer
 Phone
Spouse's Employer
 Phone
Number of children living in home
Ages
Other than immediate family, list all living in your home and their ages.
Previous address if less than 2 yrs.......................
How long have you lived at this address?
Years there
What is the best way to contact you?
 Phone?
 Email?
 When?
Pet Information
No
Yes
Have you ever owned a Yorkie?
 If Yes where is it now?
Do you have other pets?
 List breed age and sex
Are all pets current of all vaccinations?
 Are they spayed/neutered?
If no to either explain
Are all pets on heartworm preventative?
Brand
Are all pets on flea control?
 Brand
Groomers name and phone number
Veterinarian's name and phone
Approximate date of last vet visit for each pet
List all pets you've owned in the past 10 years, not mentioned above, and their present status
General Information
How did you hear about Yorkie Friends Rescue?
Please list any Breed Clubs, Humane Societies, Training Clubs,or similar organizations to which you belong?
Please provide the name, address, and phone number for 3 professional or personal references.
Information Specific to Adoption
Is the adopted dog for your personal companion?
If not, for whom is the dog?
We do not adopt dogs as gifts for other parties.
Why do you want a Yorkie?
Is everyone in your home agreeable to adopting a rescue dog?
If not, who and why not?
Please check the term(s) that best describes your current living situation.
House
Condo
 Apartment
 Modular Home
Rent
 Living with Parents
Own
Phone
If renting, Landlord's name
If living with parents, Parents' Names
Phone
If renting or living with other parties, are pets allowed?
Social Environment: Check One
 Country
Urban
 Suburban
Does your home have a backyard?
Is it fenced?
Fence type
Fence height
Will gate be pad locked?
 Is fence permanent?
Is edge of fence buried to prevent tunneling?
Does your home have a swimming pool or a hot tub?
 Yes or NO.
If yes, are they secured with proper fencing around that area?
Will dog be left alone during the day?
For how long?
Days per week
Where will the dog stay while you are gone?
Specifically what will be the dog's living situation? (Examples-run of house, confined to one area, garage or basement)
Will the dog be crated?
 If so for how long?
 How often?
Have you ever adopted any animal before?
Explain
Phone
From what agency did you adopt?
Do you prefer male or female?
 Age range?
 Size?
Do you understand that often times the complete history of a rescue dog may not be known?
Will you be willing to work with us to correct any possible behavior problems?
Social/Behavioral problems you could not handle: Check all that apply:
Soiling floor
Dog/cat aggression
 Excessive barking
 Other
Will you take the dog to obedience training?
 If so, where?
Will you always maintain necessary vaccinations for the dog?
Provide necessary veterinary care and treatment?
Have annual heartworm test?
Maintain regular heartworm & flea prevention?
Medical condition(s) you are not able to handle