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PRE-ADOPTION QUESTIONNAIRE – Flamingo Shih Tzu (Please print)
Date___________________
Name: ____________________________________________ Street Address ___________________________ Home Phone: _____________________________________ Cell phone_____________________________ City: ____________________________ County: _________________State: ______________ Zip: _________ E-Mail: __________________________________________________________________________ Occupation: ___________________________________________ Work Phone: __________________________ Spouse/Partner Name & Occupation: ______________________ Cell Phone: __________________________
In order to be considered for an adoption, you MUST: ¨ Be 18 years of age or older ¨ Have identification showing your present address ¨ Have knowledge and consent of landlord/homeowner (if applicable) ¨ Be able and willing to spend the time and money necessary to provide grooming, training, medical treatment and proper care for a pet. ¨ The questions here are asked to assure this pup goes to a good permanent loving home.
Why do you want to adopt a dog/puppy? _______________________________________________________ Do you: Do you live in a: If so, Landlord Name: _____________________Phone: _______________
Please list the name of all household members. Include ages for household members under 18 _______________________________________ ________________________________________ _______________________________________ ________________________________________ _______________________________________ ________________________________________ For whom are you
adopting this pet? Who will be primarily responsible for the care and supervision of the animal? _________________________ Will this dog be
in the presence of children frequently? Do any household
members have known allergies to dogs? What will happen to this dog if you move? ___________________________________ Are you prepared
to accept the cost of a dog in a home? Do you have a
veterinarian for your pet(s)? Approximate date of last vaccinations for current pet(s): _________________________ I understand that grooming costs will run about $50.00 every 4-6 weeks________________________ As an adult, have
you owned a dog)? If yes, what breed(s)? __________________________ How active of a
dog do you want? How many hours each day will your dog be left alone? ___ How will the dog be confined? ___________________________________________________________________________ All dogs are sold with Limited AKC registration, and will not be eligible for breeding. Do you plan on neutering your Dog when it is 5/6 months old? Please list all pets that you have had in the past five years (both current and those you no longer have):
Do you have a
fenced in yard? Will you
micro-chip this animal? Do you want to
house the dog/puppy indoors? Do you want to
house the dog/puppy outdoors? How will you keep the dog/puppy confined to your property? _____________________________________ Are you
willing to housetrain this dog? Do you plan on
attending do training classes with your new dog? For what
potential problems do you feel unprepared for? References: List two references with home address and phone number Name: _________________________________________ Phone: ___________________________________ Address: _________________________________________________________________________________ Name: _________________________________________ Phone: ___________________________________ Address: _________________________________________________________________________________
I CERTIFY THAT THE ABOVE IS TRUE. I agree that Deb Waddell of Flamingo Shih Tzu will be notified first if I am no longer able to keep my dog for any reason. Deb will approve any new home for my dog, or help me to find an appropriate home. This dog will never be sold or turned over to a pet shop, laboratory, auction, wholesaler, dog pound or humane society. Flamingo Shih Tzu can/ will care for the dog until a new home can be found if necessary
(Over 18 years) Signature: _______________________________________ Date: ____________________
Mail or e-mail this form to me Attn- puppy adoption application Deborah Waddell 3607 NW Catawba Rd Port Clinton Ohio 43452
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