(STRMN does not allow a person to apply for a dog to give as a gift)

*Please answer all questions

Personal Information  
   
Your Name
Co-Applicant Name, if any (if none, enter None)
Address
City, State, Zip
Home Phone Number
Work Phone Number
Email Address
Best time to reach you
Your Occupation/Work Place
Household Members, and their ages
Do you have children other than those living at home, or grandchildren, that would be visiting frequently?
Briefly tell us why you want to adopt a Shih Tzu:
   
Housing  
   
What type of home do you live in?
Do you Own or Rent?
Do you have a fenced in yard?
Describe your fence (type, height). If none, enter None.
If no fence, how will the dog get exercise or relieve itself?
Does your home have a swimming pool?
If Yes, is it fenced in?
Do you have restrictions regarding pets in your association or neighborhood?
Does your town or city have restrictions on the number of pets you can own?
Are you planning on moving in the near future?

If and when you move, will you look for housing where pets are allowed?
Are there smokers in the household?
   

Preferences:

  
   
Briefly describe the dog you would like:  Age, gender, personality, etc.
Is there a particular dog we have up for adoption that you are interested in? 
If yes, which dog?
Would you consider adopting a pair if they can’t be separated?

Are you willing to adopt a dog that may have experienced some form of abuse or neglect that might require extra love and patience to get over some shyness and/or fears?

Are you willing to adopt a dog that has special medical needs and might require a special diet, medications (a pill, eye or ear drops) etc.?
Are you willing to consider a Shih Tzu Mix?
Have you ever had a Shih Tzu before? 
   

Care and Responsibilityy

  
   
Are you aware of the special grooming and common health problems of the Shih Tzu breed? 
Are you willing to pay a groomer to groom your Shih Tzu every 6-8 weeks?
Are you willing to brush the dog's coat daily, pluck the hair from inside the ears to prevent infection (performed by you, a Vet, or a groomer), and clean the eyes daily if necessary?
Can you commit to providing all necessary medical care for this dog for its lifetime? 

What provisions would you make for this dog if you were unable to care for it any longer?
How many hours would your dog be left alone each day?

Where will your dog be kept during the hours he/she is left alone?
If necessary, would you be able to come home after 4 hours to left the dog out to relieve itself, or make arrangements for someone else to do so?

Where will your Shih Tzu sleep at night?

How long will your Shih Tzu be left outside?

Who will have primary responsibility for caring for the dog?
Does anyone in your home have allergies or asthma? 
If Yes, please explain:
What will you do if a family member or current pet does not get along with your new Shih Tzu?
Are you willing to re-housetrain your Shih Tzu during the transition period in your home?
Describe your method of discipline for a dog:

Who will watch your dog when you are out of town or on vacation?
   

History of Pet Ownership

  

What dogs do you currently have? (please include name of dog, breed, gender, whether spayed or neutered, age, how long owned, and where kept), what year did you get them?
Dog's Name Breed Gender Spayed/Neutered Age
 

Do you have any other pets?  If yes, please describe:
Species: Breed: Gender: Spayed/Neutered Age
 
**Upon the advice of our Canine Eye Specialist, we are hesitant to adopt a Shih Tzu into homes with cats that are not declawed. This is because of the Shih Tzu protruding eyes, and their inquisitive, playful nature with many cats. However, each home will be evaluated individually in this regard.
Dog's Name Breed Gender Spayed/Neutered Age
How many years did you own this dog?
What happened to this dog?
 
Dog's Name Breed Gender Spayed/Neutered   Age
How many years did you own this dog?
What happened to this dog?
 
Dog's Name Breed Gender Spayed/Neutered   Age
How many years did you own this dog?
What happened to this dog?
 

References:

Please provide THREE references, to include your Veterinarian and Groomer if you have one. Only 1 relative may be used. If you rent, you must include your landlord as a 4th reference. Please contact your references to let them know they may be called.
   
Veterinarian/Clinic:  
Name:
Address:
Phone:
Best time to call:
   
Groomer:  
Name:
Address:
Phone:
Best time to call:
   
Reference #1  
Name
Address:
Phone:
How does this reference know you?
Best time to call:
   
Reference #2  
Name:
Address:
Phone:
How does this reference know you?
Best time to call:
   
Reference #3  
Name:
Address:
Phone:
How does this reference know you?
Best time to call:
   
Landlord:  
Name:
Address:
Phone:
Best time to call:
 
Please add any other additional comments you have that you feel will help us in evaluating this application:

(Check Here)  I certify that the above information is true and correct and I have not omitted any information.

By submitting this form to STRMN, this constitutes your electronic signature hereon. STRMN may also require that you submit an original signature via U.S. Mail Service.