Furever Shih Tzu & Companion Dog Placement Questionnaire & Application

Me and my Family

If you were referred by a rescue member, please enter member name:

E-mail:  
Name:     Home Phone: 
Address:  Work Phone: 
City:     State:  Zip:      
Best Time to call: 
Please Note: We must know your state to process the 
application and you must be 21 years old to complete an 
application. If you do NOT include an email address, 
we may not be able to process your application.

Number in household? 
Please select
1
2
3
4
5 or more
 Children?
Please select
Yes
No
 

 If Yes, what age? 

Please tell us the name, age and sex of each of the members of your household.

Does anyone in your household smoke? (Some pug nose dogs do have respiratory problems with second hand smoke.) Please select Yes No Occasionally

Are you expecting a child, or planning a family in the future? (Many toy breeds and Shih Tzu are not good with small children and we would not want to place a dog who didn't like children with anyone who was planning a family.) Please select Yes No Possibly
If yes, will this will affect any of the living conditions of the animal you are wanting to adopt? Please explain:

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Preferences

Please check any preferences on sex. Please note:The average age of a rescue is between 2 - 7 years of age and all rescues will be spayed/neutered before adoption. NO EXCEPTIONS! Please don't ask us for an unaltered dog. Shih Tzu frequenty live 16 - 18 years. If you prefer a younger Shih Tzu, your wait may be slightly longer. We rarely have puppies.

Sex: Please select Male Female Pair No preference

If you are interested in a particular dog, please tell us the dogs name and which petfinder site you saw it on. The application will be forwarded to the family fostering that dog.

Have you applied with any other rescue group(s) to adopt? Please select Yes No Not recently

If the above answer is yes, please tell us the names of the other groups you have applied to.

Are you willing to travel to pick up your new family member? (Many of our dogs are not fostered locally) Please select Yes No Not sure

Are you willing to accept a dog with special medical needs, such as eye drops or a special diet or a daily medication? Please select Yes No Possibly
Please explain any reservations or limitations you might have.

Are you willing to accept a dog with a history of neglect/abuse who needs extra love and attention and may take extra time to adjust to your household or is especially fearful of new situations? Please select Yes No Possibly
Please explain any reservations or limitations you might have.

Are you willing to accept a dog with behavior problems who requires special training, such as housetraining, toy or food aggression or needing to be an only dog? Please select Yes No Possibly
Please explain any reservations or limitations you might have.

Would you consider a mix breed such as Shih Tzu/Poodle? Please select Yes No

How long are you willing to wait to adopt your new family member? (Our adoption process usually takes at least 2 weeks so if you indicate a shorter time we may be unable to process your application)

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Why A Shih Tzu or high maintenance dog?

Have you previously owned a Shih Tzu or high maintenance dog? Please select Yes No

Have you read "Things You Need To Know Before You Adopt"? (If you have not, we will ask you to read this prior to processing your application): Please select Yes No

What do you like about the breed you are applying to adopt?

What other breeds have you considered and why?

Please describe what you feel are the characteristics of the ideal dog for you and your family.

The Shih Tzu and many other long hair toy breeds are a high maintenance dog, and while you may love the breed you may discover that you do not have the time or the resources to devote to its upkeep. But if you do, the furbaby will more than repay you with a lifetime of loyalty

Are you prepared to pay someone up to $40, or more, every 4 to 6 weeks to groom your dog? Or are you prepared to purchase a grooming table, clippers, scissors and other accessories and devote the time to learn to groom your high maintenance dog yourself? Please select I am not sure how I will handle the grooming I am willing to pay for grooming I can purchase supplies to groom them myself

Are you willing to spend approximately one hour each week brushing and combing out your Shih Tzu or high maintenance dog? This additional maintenance is required whether the dog is being professionally groomed or you are grooming your dog yourself. I am not sure I have the time to do this Please select I have concerns with some of the above I had not thought of this additional care I am willing to do this

Are you willing to pluck the hair from the inside of the ears monthly to prevent infections and to clean the eyes of accumulated matter daily if necessary? I am not sure I can do this Please select I have concerns with some of the above I had not thought of this additional care I am willing to do this I will have a professional do this

Are you willing to clean the eyes of accumulated matter daily if necessary? I am not sure I can do this Please select I have concerns with some of the above I had not thought of this additional care I am willing to do this

Are you prepared to deal with the cost of both routine veterinarian care (worming, annual shots) and non-routine/emergency veterinary care, especially as the dog gets older? Yes Please select I have concerns with some of the above I had not thought of this additional care

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Your Home

Which of the these best describes your current residence? Please select Other Own a single family home Rent/Lease a single family home Own a townhouse Rent/lease a townhouse Rent/lease an apartment Trailer or mobile home

Does your lease or home owners assoc. restrict pet ownership? Please select Yes No Don't Know

Does your town or city have restrictions on the number of dogs you can have? Please select Yes No Don't Know

Is your yard, or a portion of your yard, securely fenced? Yes Please select No

If you have a pool, is it fenced? Please select No Yes Not Applicable

If you have a dog run, is it secure? Please select No Yes Not Applicable

If you do not have access to a fenced area, please explain how you plan to exercise your Shih Tzu and allow it to relieve itself?

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References

Name, Phone number (with area code), best time to call and relationship to applicant (partial/missing information can delay processing of your application):

Care and Responsibility

Approximately how many hours a day will your new dog be alone? 2 hours or less More than 2 hours, but less than 4 More than 4 hours, but less than 6 More than 6 hours, but less than 8 Please select More than 8

How long will the dog be left outside?

Where will your dog be when left alone? Loose indoors Crate Kennel run Loose outdoors in fenced yard Please select Other

Where will your dog sleep at night?

Who will have primary responsibility for the care of your dog?

Do you travel frequently? No Please select Yes If yes, who will take care of your dog when you are away?

Have you asked yourself whether your lifestyle is so busy you might not have the time or energy to properly care for a high maintenance dog?

Are you willing to restrict your choice of housing to places where pets are allowed?

Does everyone in the family want a new dog?

Does anyone in the household have any known allergies to animals?

What is your definition of disciplining a dog?

What will you do if your spouse, children or pets can't get along with the dog?

History of Pet Ownership

What animals currently live in the household? (Please list type of animal, sex, altered or not, age and how long you have owned them, and are they inside or outside animals)

Please list any dog you have owned in the past, name, breed, how long owned, explain what happened to it, including the age it died or left you.

All of the information I have provided is true and complete to the best of my knowledge.
Should a dog be placed with me it will reside in my home as a pet. I agree to provide the dog with adequate food, water, shelter, affection and medical care.

Signature of Applicant:

Date of Application:

How would you like us to contact you?

Send E-mail (We recommend this method)

Please call (If there is no member in your local area and you select this method you may be called collect)