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Adoption Application

Tarlov Cyst Disease Foundation P
Part I: Personal Information

 Date:
Address:
City:
State:
 Zip:
Evening Phone:
E-mail address:
Number of adults in the household:
 Men / Ages:

Women / Ages:
 Number of children in the household:
Boys / Ages

Girls / Ages
Are you expecting a child or planning a family in the near future?

Type of Dwelling:
House
Apartment
Trailer
Condo/Townhouse
Duplex/Triple
Other - Explain
Do you own or rent?
own
rent
If you rent, do you have the landlord’s permission to keep a dog?
yes
no
Please provide Landlord/Apartment contact information for verification:
How many consecutive hours a day are you away from home for work, school etc.?

Will you be hiring a pet sitter if gone a long time or are you close enough to go home during the day?
Part II: Type of Rescue
If interested in a particular pug, please specify who:
Are you agreeable to returning the pug, should unforeseen circumstances arise wherein you would no longer be able to keep them?
Would you be willing to allow us to visit your home?:
Have you applied with another Rescue Group? If so, which organization?
If out of state, will you make provisions to get the dog?
Color Preference:
Fawn
Black
No preference

Age Preference:
Puppy (6 mos.-1 years, rare in rescue)
1 - 6 years
6+ years
No preference

Sex Preference:
Male
Female
No preference
Part III: Environmental Information
How large is your yard (approx.)?

Is it securely fenced?
Yes
No
If yes, what kind of fence and how tall?

If no, will you fence it if you get a dog?
Do you have a pool?
Yes
No
If yes, is it securely fenced?
Yes
No
If your yard is not fenced, how do you plan to insure that the dog receives safe and adequate exercise?
Where will the dog sleep?
Do you plan to keep the dog primarily indoors or out? Please elaborate.
Do you plan to use a crate?
Yes
No
Part IV: Pet History
List all pets you currently own:
Dogs:
Breed Age Spayed or Neutered? Stay Indoors or Outdoors

Cats:
Breed Declawed? Spayed or Neutered? Stay Indoors or Outdoors
Others:
Breed Age Spayed or Neutered? Stay Indoors or Outdoors
Have your current pets ever lived with a dog?
Yes
No
List any pets you have previously owned:
Species/Breed How Long Owned Kept Indoors or Outdoors? Spayed or Neutered? Where is pet now? If deceased, cause of death?
Have you ever had to give up a pet? If yes, please tell us why:

If you currently own a dog, or have ever owned one in the past, please complete this portion. If not, please skip this box.
Where did you get this dog(s)?

What type of Heartworm Preventative do you give your dog?

What type of flea control do you use on your dog?

What do you feed your dog (brand/type)?

Is your dog spayed or neutered?
yes
no
Why or why not?

When nobody is home, where does your dog stay?
In the yard
In a crate
In the garage
In the house, confined to an area
In the house, not confined to an area
In the house with a doggie door
In an outdoor dog run/pen

Do you consider your current dog(s) aggressive or submissive to other people? Animals?
Part V: Behavior
What amount of time and effort, per week, do you want to devote to training your dog?
3-5 hours
5-7 hours
7-10 hours
10+ hours
Which family members would be expected to assist in home training?
What is your definition of disciplining your dog?
What are your training objectives?
What makes you a good pet owner?
Part VI: Pug Knowledge
Are you aware of pug health problems?
yes
no

If yes, what problems do you foresee (please explain)?

Are you willing to take care of said problems should they arise, even if he/she requires
daily medication?
yes
no

Are you aware that pugs shed 365 days a year?
yes
no

Did you know that pugs snore?
yes
no

Pugs are companion animals and they want to be with you constantly. Pugs were bred
solely for companionship. Are you prepared for this?
yes
no

Do you realize that pugs can live upwards of 14 years and are you committed to caring for one for that long?
yes
no

How did you find out about us?

Please let us know anything else that would make you an ideal candidate for a rescue pug:
Part VII: References
Please list three references below that can attest to your suitability as a pet owner, and more specifically, the owner of a rescued dog.
Reference #1 (current vet if applicable, or the vet that you plan to use in the future)
Reference #2
Reference #3
I, the undersigned, attest that, to the best of my knowledge, the above information is accurate and complete at the time of signing. I understand that falsely provided information can mean that my application will be terminated.
In order to complete the adoption process, it is imperative that you read and understand the following information PRIOR to completing an application. Failure to accept or understand one or more of the options will automatically disqualify your application. Please read carefully. This is important.
Adoption Donation Guidelines*
 

Puppies to 1 year:

$350.00

1 year to 10 years:

$300.00

Seniors over 10 years:

$250.00

*Donation may vary depending on each Pugs individual needs.

Statements of understanding

The purpose of Pug adoption is to provide a healthy, happy home for the lifetime of the pug. It is not to provide a low-cost pet. We see adoption as a privilege that families are selected for based on individual merit, not on a first come basis.

The adoption fees are used towards support of the pugs. Money is used for vet bills, medicine, food, toys, and other supplies. Absolutely NO money is paid to volunteers for salaries or mileage. Extra funds are used for rescue efforts.

All applicants must be legal adults (over the age of 18) with a means of supporting a pet PLUS any unexpected medical issues. Stability is very important. Many pugs will have one thing or another happen during their lifetime that requires some form of attention.

The needs of the pug are most important. Pugs need stable homes quickly. Pugs need to settle in to a home and not to bounce from foster to foster. They need affection and tender loving care.

NIPRA makes the effort to perform as many home visits as possible. We often get over ten applications per day covering multiple states. We can not visit every home in our spare time, thus will attempt to do as many as possible in accordance with concentrated application areas. It can easily take a month or more before going to some areas.

NIPRA can not guarantee that a pug will be housebroken. Any time an animal enters a new environment it needs to learn where to go potty. It is like any of us entering a place and not knowing where the bathroom is, except pugs can't ask!

NIPRA can not make any guarantee of a pug's age. We do disclose ALL paperwork and information given to us, however, the paperwork is more often inaccurate due to cost cutting at the mass breeding level.

Pugs will not be placed into home with animals that are not altered (unless due to age or health restrictions). You should care enough about your animals to spay or neuter them.

Pugs can not be shipped. They must be picked up. We make the effort to visit your home, you should make the effort to pick up your new family member. It's a fair trade off that displays your commitment.

You may visit and meet your adoption candidate prior to adoption. This is encouraged, but not mandatory. If a pug does not fit with the rest of the family, you may bring him/her back for placement with another family. Your donations are refundable for up to two weeks under these circumstances or you may opt to wait for another candidate that may work out better.

We can not guarantee compatibility with other existing animals but you are welcome to bring them along to meet and visit prior to adoption. You may visit with the pugs by appointment once your application has been approved.

Adoptions outside of a 100 mile radius of the Chicago area may require payment of adoption fees by money order or cash. Please ask prior to coming for your pug.

Home visits provide a good channel to ask questions. There is no "Pass" or "Fail" to a home visit, but feedback is used to help indicate a "best fit" for each individual pug.

This long list of rules is a result of circumstances that have happened within the first three months of NIPRA's existence. Before applying for adoption, please understand what the purpose of adoption is and is not. Misunderstanding can cause delays in finding the right home for a pug or worse. If you cannot comprehend the purpose of adoption, it may not be for you. There are many families that want to open their homes to a pug that needs a "Forever Home". Please respect the needs of pugs by submitting only serious applications. If, for any reason, you no longer would like to be considered for adopting, please send an e-mail to nipra@northernillinoispugrescue.org indicating that you are no longer wishing to adopt. This courteous action may help expedite placement for someone else!

Adoption saves lives!
 
 
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