Personal
Information
Your Name
Co-Applicant Name, if any (if none, enter None)
Address
City,
State, Zip
Home Phone
Number
Cell Phone
Number
Work Phone
Number
Email
Address
Best time
to reach you
Your
Occupation/Work Place
Household members, and their ages (including your own
Do you have
children other than those living at home, or grandchildren, that
would be visiting frequently?
Select One
Yes
No
Briefly
tell us why you want to adopt a Shih Tzu:
Housing
What type
of home do you live in?
Select One
Single Family Home
Townhome/Condo
Apartment
Other (describe)
Other Described
Do you Own
or Rent?
Select One
Own
Rent
Do you have
a fenced in yard?
Select One
Yes
No
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?
Select One
Yes
No
If Yes, is
it fenced in?
Select One
Yes
No
Do you have
restrictions regarding pets in your association or neighborhood?
Select One
Yes
No
Does your town
or city have restrictions on the number of pets you can own?
Select One
Yes
No
Are you planning
on moving in the near future?
Select One
Yes
No
If and when you
move, will you look for housing where pets are allowed?
Select One
Yes
No
If Possible
Are there
smokers in the household?
Select One
Yes
No
Yes, but not in the house OR in the car with pets
(This breed has very short nasal passages, and because of this can
be prone to respiratory and allergy issues. STRMN does NOT allow
adoptions to homes with smokers. The dog’s future health is our
priority.)
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?
Select One
Yes
No
If yes,
which dog?
Would you
consider adopting a pair if they can’t be separated?
Select One
Yes
No
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?
Select One
Yes
No
Would like more information
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.?
Select One
Yes
No
Would like more information
Are you willing
to consider a Shih Tzu Mix?
Select One
Yes
No
Have you ever
had a Shih Tzu before?
Select One
Yes
No
Care and Responsibilityy
Are you aware of
the special grooming and common health problems of the Shih Tzu
breed?
Select One
Yes
No
Are you willing
to pay a groomer to groom your Shih Tzu every 6-8 weeks?
Select One
Yes
No
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?
Select One
Yes
No
Can you commit
to providing all necessary medical care for this dog for its
lifetime?
Select One
Yes
No
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?
Select One
Yes
No
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?
Select One
Yes
No
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?
Select One
Yes
No
We cannot guarantee a dog is 100% housetrained.
Most have begun housetraining in their foster homes; however, ALL
dogs will have to be re-trained to some extent at their adoptive
homes, due to a new sleeping and feeding routine. This not just for
rescue dogs, ANY dog going to a new home will have to be re-trained
at least to some extent!
Describe your
method of discipline for a dog:
Are you able to physically walk/exercise a dog 2 times a day?
Select One
Yes
No
Are you willing to commit to doing this if this dog needs exercise?
Select One
Yes
No
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?
Do you have any
other pets? If yes, please describe:
**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. Please list all the dogs you have
had in the past and explain what happened to them (please
include name of dog, breed, gender, whether spayed or neutered, age,
how long owned, and what happened to them):
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.
