Interested in:
Sir Hershey (002487)
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Postal Code:
Home Telephone:
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Preferred contact:
e-Mail:
Do you presently care for/own any pets?:
If yes, please list name, species and breed (e.g., Sylvester, Cat, Tabby; Tweety, Bird, Canary; Snoopy, Dog, Beagle):
Our dogs are spayed or neutered
prior to placement unless they are too young or too old to have the surgery performed.
Chihuahua Rescue, USA, requires that dogs in your home be altered prior to allowing one
of our animals to be adopted unless a medical or other condition exists that prevents spay
or neuter. We may be able to provide low cost spay/neuter options in your area if you
require assistance. If you answer 'No' below, please include the reason why. Failure to
comply with these very specific instructions will result in the application not being
processed.
If dogs are present, are each spayed/neutered?:
If no, please explain why not:
Please provide the name and telephone number of your current vet:
Please contact your vet immediately after completing this application
to grant permission to Chihuahua Rescue, USA, to communicate with them
with regard to your relationship.
Have you cared for/owned any pets in the past?:
If yes, please list name and type and what happened to them (e.g., Snuggles - Cat - Passed Away, Tweeter - Bird - Flew Away):
How many children living in the household?:
Do you own or rent?:
Do you reside in a house, apartment, other?:
If renting, do you have landlord permission to keep a dog?:
If you have a fence, what kind?:
How many hours, if any, will your dog be left unattended?:
Where will the dog be kept while you are away?:
Do you have enough crates to house dogs in your household?:
Where will the dog be kept while you are on vacation?:
Why are you interesting in adopting a dog?:
Do you have a preference for sex, size, color, mix or a dog currently listed on our website?:
Will you allow a home visit prior to adoption?:
Will you enroll the dog in obedience classes, if necessary?:
Will your dog always be on a lead when in open spaces?:
Please provide the name and telephone number of one or more personal reference(s): (Limit to 500 characters)
Where did you hear/learn about us?: (Limit to 500 characters)
Feel free to include any additional comments regarding your application below: (Limit to 500 characters)
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