Adoption Application - Chihuahua & Small Dog Rescue

We do not adopt to anyone living outside the state of Colorado. No Exceptions!

Your Name

Your Email

Spouse's Name

Your Marital Status

Street

City

State

Zip

Which county do you live in?

Home Phone

Cell Phone

Work Phone

How long have you lived at your current address?

Is your residence a/an:

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 virtual home visit with everyone in your household and your pets 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?

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.