Before any of or Pei are placed in a new home we insist this be competed!!

 

 

Shewrinkles Shar-Pei Puppy Adoption Application

 

 

 

 

 

 

Last Name: First:

Address:

City:

State: Zip:

Phone(Home):

Phone(Work):

Phone(Cell):

Email:







1. Who will be responsible for the pet?

2. Have you ever had a pet before?Yes No
If yes, please fill in all details below:

Pet#1 name: Type: Dog Cat Bird Reptile Rodent Other Age: Less than 1 yr. 1-3 yrs 4-6 yrs 7-9 yrs 10-12 yrs 13+ yrs
Owned from / / to / /
Reason pet is no longer in your care:

Pet#2 name: Type: Dog Cat Bird Reptile Rodent Other Age: Less than 1 yr. 1-3 yrs 4-6 yrs 7-9 yrs 10-12 yrs 13+ yrs
Owned from / / to / /
Reason pet is no longer in your care:

Pet#3 name: Type: Dog Cat Bird Reptile Rodent Other Age: Less than 1 yr. 1-3 yrs 4-6 yrs 7-9 yrs 10-12 yrs 13+ yrs
Owned from / / to / /
Reason pet is no longer in your care:

3. Do you live with other pets at home? Yes No
If yes, please complete the following:

Pet#1 name: Type: Dog Cat Bird Reptile Rodent Other Altered/Neutered? Yes No    Vaccinated? Yes No
Where Kept?

Pet#2 name: Type: Dog Cat Bird Reptile Rodent Other Altered/Neutered? Yes No    Vaccinated? Yes No
Where Kept?

Pet#3 name: Type: Dog Cat Bird Reptile Rodent Other Altered/Neutered? Yes No    Vaccinated? Yes No
Where Kept?

Pet#4 name: Type: Dog Cat Bird Reptile Rodent Other Altered/Neutered? Yes No    Vaccinated? Yes No
Where Kept?

4. How often do you take your pet to the Veterinarian? Monthly Twice yearly Yearly Every other year Every third year Other
If "other" is selected, please explain:

a. Date of last visit? / /
b. Name of Vet?
c. Address: City: State: Zip:
d. Vet's phone number? - -

5. I live in a House Townhouse Condo Apartment Other

a. Rent or Own? Rent Own
b. Landlord's name?
c. Landlord's phone number? - -

6. How long have you lived at your current address? 6 months or less 1 year or less 2-5 yrs 6-9 yrs 10+ yrs

7. How may people live in your household?
Please fill in the information below:
a. Name: Adult Child    Age: Infant 1-3 yrs 4-6 yrs 7-9 yrs 10-12 yrs Teenager
b. Name: Adult Child    Age: Infant 1-3 yrs 4-6 yrs 7-9 yrs 10-12 yrs Teenager
c. Name: Adult Child    Age: Infant 1-3 yrs 4-6 yrs 7-9 yrs 10-12 yrs Teenager
d. Name: Adult Child    Age: Infant 1-3 yrs 4-6 yrs 7-9 yrs 10-12 yrs Teenager
e. Name: Adult Child    Age: Infant 1-3 yrs 4-6 yrs 7-9 yrs 10-12 yrs Teenager

8. What is the longest period of time the animal will be left alone? 1-3 hrs 4-6 hrs 7-9 hrs 10-12 hrs More than 12 hrs

a. Where will the animal be kept during this time?
b. Where will the animal be kept when the family is home?
c. What would you do if your pet chews the furniture or displays other destructive behavior?

9. What is your reason for adopting this animal?
      (Please choose all that apply)

House Pet Guard Dog Watch Dog
Companion Pet Companion Backyard Pet
Gift Breeder Other
If "other" was selected, please explain:

10. Please choose yes or no for the following questions:
a. Are you familiar with housebreaking? Yes No
b. Are you familiar with crate training? Yes No
c. Are you familiar with licensing laws in your community? Yes No

11. Does your yard have a fence? Yes No   If yes, how high? 3 ft 4 ft 5 ft 6 ft More than 6 ft    Type: Picket Chain-linked Stockade Other

13. Are you willing to agree to 3-month, 6-month and yearly follow up visits? Yes No

14. Please provide one personal reference who can recommend you as a responsible pet owner:
Name:
Phone: - -
Relationship to applicant:

By submitting this application, you certify that you understand and agree to the following:

§   Shewrinkles Shar-pei may contact anyone listed on this form.
§   You have answered all questions honestly and accurately.
§   Shewrinkles Shar-pei reserves the right to refuse any adoption without further explanation!!!