Adoption Application Name Stop here if you do not live in Colorado. We do not adopt to anyone living outside the state of Colorado. No exceptions! Your Name * Your Email * Spouse's Name Your Marital Status Select One Married Single Street * City, State, Zip * Which county do you live in? * Select One Adams Alamosa Arapahoe Archuleta Baca Bent Boulder Broomfield Chaffee Cheyenne Clear Creek Conejos Costilla Crowley Custer Delta Denver Dolores Douglas Eagle El Paso Elbert Freemont Garfield Gunnison Hinsdale Huefano Jackson Jefferson Kiowa Kit Carson La Plata Lake Larimer Las Animas Lincoln Logan Mesa Mineral Moffat Montezuma Montrose Morgan Otero Ouray Park Phillips Pitkin Prowers Pueblo Rio Blanco Rio Grande Routt Saguache San Juan San Miguel Sedgwick Summit Teller Washington Weld Yuma Home Phone * Cell Phone * Work Phone * How long have you lived at your current address? Is your residence a/an: Apt/Condo Single Family Townhome Trailer Farm Do you (check one) Own Rent If you rent, please provide landlord's name and phone number: Your Birth Year Spouse's Birth Year Your Occupation Spouse's Occupation How many adults in your household? How many children in your household? What are the ages of your children? If no children, do you plan on children? Yes No How many dogs in your household? * How many cats in your household? * How many other types of pets in your household? What are they? What breed(s) of dogs do you currently have? Are they all spayed/neutered? Yes No Are they all current on their vaccinations? Yes No Are you willing to permit a home visit with everyone in your household being present? Yes No Does anyone in your household have allergies to hair or dust? Yes No Are there any aspects of your home that a dog can affect (white carpet, antiques, etc.)? Yes No What is the name and location of your veterinarian? What types of little one are you interested in? Check all that apply Male Female Either Puppy Young adult Older dog Special needs Are you familiar with the characteristics and temperament of the dog you are choosing? Yes No What type of temperament would best suit your family? Check all that apply. Dominant Submissive Natural Leader Friendly Shy Easy-going Mild-tempered Aggressive Follower Aloof Hyper Laid back Where will the dog live? * Inside Outside In a kennel When dog is outside, will the dog be? In a fenced yard In a kennel Free to roam In the garage In the basement Tied or chained outside Where will the dog be when you are home? Where will the dog sleep? What do you like about the breed? Are you aware that the dog you will be adopting is spayed/neutered? Yes No Are ALL family members in agreement about adopting a dog? Yes No What is your family's activity level? Athletic Moderate Medium Low Retired Are you prepared for the financial responsibility of owning a dog? Yes No Will you take the dog to obedience classes if needed? Yes No Will all family members be involved with the care of the dog? Yes No Who will be the primary caregiver of the dog? Is there a leash law where you live? Yes No How many pets can you legally own? How did you learn about Chihuahua & Small Dog Rescue Our little ones are all in foster homes up and down the Front Range. Are you will to travel to meet and spend time with the little one you are interested in? Yes No What made you decide to adopt through a rescue organization? Please list two people you know well and who can attest to your character. Please provide name, relationship to you, phone number, and length of relationship Please list any other information/comments you feel may help us in placing the right dog in your home: What is the name and his/her ID number of the dog(s) in which you are interested? Important -- please read Please be advised that we are all volunteers dealing with identifying and/or pulling rescue dogs from shelters, picking up Owner Surrenders, going on home visits, coordinating foster homes, and transporting rescue dogs to the vet for vet care or to a new home. The list is endless. Therefore, if we have not contacted you within a week of submission of this application, please feel free to contact us. I certify that the information contained in this application is true and correct and I understand that prior to the placement of a rescue dog in my home, the information will be verified. I also agree to a personal interview to determine the suitability of my home and family to care for a dog. I agree to allow a Chihuahua & Small Dog Rescue, Inc., representative to visit my home. I am also aware that there is an adoption fee for the dog. I give CSDR permission to contact my veterinarian and to verify the information in this application. Signature (your typed name is your signature) * Date * Verification Please enter any two digits * Please click the submit button only one time. When you see the thank you message, your form was submitted.