First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone
Work Phone x
Cell Phone*
Which animal are you interested in* Choose an animal: Draco Goblin Shadow
What is the nearest major city?
Age of applicant*
Occupation of applicant*
Spouse/Significant Other name, age, occupation.*
How many adults in your home? List name, age, relation.*
How many children in your home name, ages?*
If no children, do you plan on having any, and if so, when?*
How often do you have visitors? * Choose one: Daily Weekly Monthly Few times a year None
Does anyone in the home have any animal related allergies? If so, please explain:*
Who will have primary responsibility for the dog?*
Have you ever owned a french bulldog? Choose one: Yes No
Have you owned a brachycephalic (short nosed) dog before? If yes, please explain.*
If you currently own a dog/dogs please list their name, age, sex, breed and if spayed/neutered.*
If your current dog is from a rescue/shelter please list the name of the facility.*
How many dogs have you owned in the last 5 years (not including your current dogs)? Please list their name, age, sex, breed and if spayed/neutered. *
If you no longer have the dog/dogs listed above what happened to them?*
Please list all other pets in the home, thier name, age, breed and if they are spayed/neutered.*
Is your dog good with other dogs? Please describe.*
Have any of your current or past pets been outdoor only?*
Have you ever had to housetrain a dog before? If yes, describe your method.*
What is your definition of disciplining a dog?*
How would you handle a dog's destructive behavior?*
Have you had to rehome any pets? Why?*
What circumstances do you feel justify getting rid of a dog?*
What brand of dog food do you feed?*
What brand of heartworm and flea prevention do you use?*
Is your dog current on vaccines? If so, please list which shots ie (rabies, dhpp, bordatella) and date last given.*
Veterinarian's Name and clinic name and phone number.*
What do you expect to be the annual costs involved in veterinary care for a dog?*
Will the animal be kept inside or outside* Choose one: Inside Only Outside Only Inside and Outside
How much time will the animal spend alone during the day?*
During the the day when you are away from home what is your plan for caring for your dog?*
How often are you away from your home on business or vacation?* Choose one: Once a week Several times a month Several times a year Couple times a year Rarely
What arrangements will you make if you have to travel?*
Do you own or rent your home* Choose one: Rent Own
In what type of home do you live* Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing
Do you have stairs in your home? If yes, please describe.*
How long have you lived at your current address?*
Are you planning on moving in the next year? If yes, please explain.*
Which best describes the area you live in?* Choose one: City Rural Suburban Urban
What type of fence?* Choose one: Privacy Wrought Iron Chain Link Invisible None
Is your yard fenced?* Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced
Do you have a pool or body of water (pond) on your property?* Choose one: Yes No
Is your pool or body of water fenced? If yes, please describe.*
Do you have air conditioning? What type?*
If you rent, have you received the approval of your landlord to have an animal Choose one: Yes No
If you rent, please enter your landlord's name and phone number
Why are you interested in adopting a pet at this time?*
Why do you feel a rescue dog would be a good match for you?*
Please tell us why you would make a great home for a dog, in particular the dog for which you are applying?*
Do you have applications pending with other rescues? If so, please list the rescue name and dog name.*
Do you agree to allow a SMRS representative visit your home prior to adoption?* Choose one: Yes No
Transportation is the responsibility of the new owner. How do you plan to pick up your new dog?*
I understand that the adoption fees can range from $300 to $600+ and I am able to pay the listed fee for the dog I am applying.* Choose one: Yes No
How did you hear about our organization?
I understand that the Application Review is as follows: 1.) The approval process begins with you completing the adoption application. Once you submit your application we do a veterinary check and if that goes well the foster home will contact you via email. 2.) During the approval process a telephone interview will be done. 3.) If the vet check and telephone interview go well you will be contacted again to schedule a home visit. Our goal of the home visit is to meet you in person and make sure the living environment is safe for the dog. All people and pets living in your home must be present during the home visit.* Choose one: Yes No
By typing my full name here, I hereby agree the terms and not to hold Short Mugs or any of its volunteers liable for any physical, emotional or property damages that are a direct or indirect result of activities involved with a Short Mugs rescue dog. Please type name (signature).*
Please type in the date of signature.*
