Polar Pug Rescue Adoption Application

Polar Pug Rescue

Adoption Application
(Please print out this application and fill in as completely as possible. If you need more writing space, continue on the back of the application.)

Date_________________________

1. Name_________________________________________________

2. Home Address (physical) ________________________________________________________________________

3. Mailing Address (if different) ______________________________________________________________________

4. Phone Number(s): Home ____________________ Work ____________________ Cell ____________________

5a. Do you live in a house? If so, do you own______ or rent______?
     Condominium or Zero-lot line? own______ or rent______?
     Apartment? _____________
     Other? (please explain below) ______
_________________________________________________________________________
_________________________________________________________________________

5b. Does your home have a fenced yard? __________

5c. If you rent, have you checked with the landlord or management to be sure you understand the rules about pets? (how many, what size, what species, etc.).________________________________

6. Have you ever owned a pug? _______ If so, how many? ____ Other dogs? ______ If so, how many? _________
_______________________________________________________________________________________________
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7a. Do you currently have any dogs? ______ What breeds and ages? ____________________________________

_____________________________________________________________________________________________

7b. Are the dogs neutered and/or spayed? _____ If not, please explain why _______________________________

8a. Do you have any cats? _______ If so, how many? ____________

8b. Are the cats neutered and/or spayed? ______ If not, please explain why _______________________________
Are the cats declawed?____________

9. Have you ever turned an animal into a shelter? ___________ If so, please explain the circumstances:
_____________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

10. Why do you want to adopt a pug? ________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________

11. Are you aware of the health risks pugs can have? ___________

12. Do all family members favor a pug coming into your household? __________ If no, please explain why__________
________________________________________________________________________________________________
________________________________________________________________________________________________

13. Do you have children? ________ If so, how many and what ages ________________________________________
________________________________________________________________________________________________

14. Where would your pug spend most of its day? _______________________________________________________
________________________________________________________________________________________________

15. How many hours will your pug be left alone during the day? ___________________________________________

16. Are you aware that pugs are indoor dogs, and will you be able to accommodate your pug in this manner?
Yes __________________ No ________________
If no, please explain ______________________________________________________________________________

17. Some pugs have medical needs (i.e. eye trouble, skin allergies, etc.), and many coming into rescue are here
because of these issues. Would you consider adopting a pug with health issues?
Are you financially able to provide any needed medical care for your pug?
_______________________________________________________________________________________________
_______________________________________________________________________________________________

18. What arrangements will you make for your pug if you must travel? ______________________________________
________________________________________________________________________________________________
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19. Do you understand that often times complete history of a rescued pug may not be known, and you may encounter some initial adjustment problems? _______________ Any questions? ___________________________________________________________
________________________________________________________________________________________________

20. Are you interested in: Male _________________ Female _________________ Either _________________
Fawn ________________ Black __________________ Either_________________

21. What age range of pug do you desire? ___________________
Please note: If you are interested in adopting a puppy (under 1-year-old),
we seldom get this age range into rescue and your wait could be a long one.

22. Would you be interested in adopting a pug mix? ____________________________________________________

23. It has been our experience that often when a pug has been either owner-surrendered, rescued from a shelter, or comes to us from a neglectful situation, they are often in need of immediate or on-going medical attention. Sometimes they are so old that they simply need a warm, loving home to rest in and be loved. Can you adopt (or foster) a pug that is in need of medical or on-going care, or is very old? ________________

24. References: Please supply the name and phone number of your current veterinarian. If you do not have a veterinarian at the moment, please supply a name of someone (not a relative) who we could call.

Vet's name____________________________ Phone Number_______________________

Friend name___________________________ Phone Number_______________________

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If you have any additional information or comments you would like to add, please do so below:

__________________________________________________________________________________________________

(Any additional comments can be written on the back of this application)

Please mail completed application to:

Polar Pug Rescue

2420 E 68th Ave

Anchorage, AK 99507

If you have any questions, call Vickie at: (907) 360-3220