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Your Full Name:
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Your Street Address, City, State, and Zip Code:
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Telephone Numbers - Home:
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Work:
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Cell:
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FAX:
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Your Email Address:
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Year You Were Born:
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Please List the Other Adults in Your Home, Their Relationship to You, Names, & Ages:
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Number of Children Living in the House:
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Please List Ages of Children:
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Do Other Children Visit? If So, What Are Their Ages And How Often Do They Visit:
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What Type of Home Do You Live In:
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House
Apt
Town-House
Condo
Mobile-Home
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Are You Applying to Adopt or to Volunteer Temporary Foster Home, Peke Transport, or Other Assistance?
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Have You Ever Owned Or Lived With A Dog Before? Please explain:
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Do You Currently Own a Pet(s):
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Yes
No
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If You Currently Own Dogs(s), Please List What Breed, How Many, and If They Are Spayed or Neutered:
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Do You Own Cat(s)?
Are They All Spayed/Neutered:
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Yes
No
How Many?
Declawed?
Yes
No
Yes
No
Peke-Friendly?
Yes
No
Unknown
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If You Currently Own Other Animal(s), Please List and Describe:
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Are You Willing To Return The Peke to NCPR Should Unforeseen Circumstances Arise:
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Yes
No
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Do You Own or Rent Your Home (If You Rent, You MUST Provide Proof of Permission to Have a Dog on the Premises)
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Own
Rent
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Landlord Name and Phone Number:
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If You Have a Yard, is it FULLY Fenced? If So, What Type, Material, and Height? If Not Fenced, How Would You
Keep Your Peke in Your Yard:
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Where Would The Peke Stay When You Are Away From Home:
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Loose Inside
Loose Outside
Fenced_Run
Tie-Out
Crated_Inside
Other
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If You Chose Other, Please Explain:
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Exactly Where Will the Peke Sleep at Night:
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Approx. How Many Hours Each Day Would The Dog Be Left Alone and Exactly Where (We Are Interested In Time Without People; Please Do Not Count Other Animals) |
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In Which Peke or Pekes of Ours Are You Interested?
If No Particular One, Please Note Your Preferences Below,
So We Can Let You Know When Such a Peke Becomes Available.
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You Want A Pure-bred Peke, Mixed breed, or No Preference:
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Pure
Mixed
No Preference
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You Want A Male, Female, or Either:
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Female
Male
Either Sex
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| Pekes can live for 20 years.
You Desire A Peke in What Age Range:
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1 to 2 Years
3 to 5 Years
6 to 8 Years
Over 8 Years
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Is There Anything Else Specific You Are Looking For In A Peke:
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Person Who Referred You to Us:
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Do You Authorize Us to Contact Your Vet, so We May Verify How Well Your Pets Were Cared For?
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Yes
No
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Please Provide Your Vet's Name, Clinic/Business Name, City, and Phone Number:
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Please Provide Name, Address, and Phone Number(s)
of a Personal Reference (Not Relative) Who Knows How You Relate to Dogs:
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Applicant Agreement:
A non-refundable adoption fee of One Hundred Fifty ($150) to Two Hundred ($200)
dollars is required for each dog adopted, unless other arrangements are deemed
appropriate. This fee is to cover cost of medical care, food, and other
necessities prior to adoption. We assure the applicant that, to the best of our
knowledge, the adopted dog was evaluated by a doctor of Veterinary Medicine,
neutered or spayed, injected with a microchip ID, and immunized.
By Clicking SUBMIT I acknowledge that I have completely read this application form,
comprehend it fully, know that applying does not ensure approval, and that untruthful
answers or failure to comply with the requirements of this application or the
signed adoption contract can result in the forfeiture of any dog adopted by me
from NCPR. Falsification of any of the
above information will be grounds to refuse my application to adopt a rescued Peke.
NCPR adopts Pekes only to homes willing to make a lifetime commitment to their
Pekes. Pekes are to be treated as family members. They require a high-quality diet
and regular medical care. Should an adopter ever have to give up the Peke, it must be returned to NCPR
at no charge to NCPR.
I HAVE READ AND AGREE TO ALL OF THE TERMS ABOVE.
Please click SUBMIT now. It will email your application to us, then return you to our home-page.
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Your Printed Name:
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(After App. Approved)
Your Signature and Date:
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Spouse/Partner Printed Name:
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Spouse/Partner Signature and Date:
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