First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone*

Work Phone
x

Cell Phone*

Alt Email

Please list the adults in the household and their ages*

Please list the children in the household and their ages *

Please list the occupation(s) of adult(s) in the household*

Are you interested in a specific dog? If so, which one?

Is there a member of your household who does not want a Pug or dislikes dogs?

Are there likely to be any major lifestyle changes in the near future? If any, please list. Examples: moving, expecting a child, caring for an elderly relative in your home, etc. *

Type of Dwelling*
Choose one: House Apartment Condo Townhouse Mobile home

Do you own or rent? *
Choose one: Own Rent

If you rent, please provide the complex name (if applicable), your landlord's name and phone number:

How long have you lived at your present address? *

Approximately how large is your yard?*

Is your yard fenced?

If your yard is not fenced, do you plan to add a fence for your pug?

If your yard is fenced, what type of fence and how tall? *

If you have no fence and no plans to add one, how will you ensure that your Pug will get adequate exercise and play time outside?

Do you have a pool or hot tub?

If yes, is the pool or hot tub securely fenced in so that the pug will not have access to it?

Do you have stairs in your home?

Does your home have air conditioning?

Where will your pug sleep at night? *

Do you plan to use a crate for your Pug to stay in when you are not home? Please explain why or why not. *

Do you plan to keep your Pug mainly indoors or outdoors? Please explain. *

Please list all current pets, INCLUDING: name of pet, type of pet, breed, age, sex, SPAYED/NEUTERED STATUS, and if they stay indoors or outdoors. If your pet is NOT spayed/neutered, please give the reason. Thank you!

Do you own cats? If yes, are they declawed? *

Where did you get your current pets?*

If you have dogs, are you involved in any activities with them? If Yes, what type of activities?

If you have dogs/cats, what type of heartworm preventative are they on?

If you have dogs/cats, what type of flea control do you use?

If you have dogs/cats, what type of food do you feed?

When you are not at home, where do your dogs stay? *

Do you consider your current pet(s) to be aggressive toward people or other animals? If Yes, please explain. *

Please list all past pets, including: type of pet, breed, amount of time owned, where kept, spay/neuter status, and where the pet is now and explanation. *

Have you ever owned a Pug?

If Yes, where did you get your Pug?

If you have ever had to give up a pet, please explain:

I have contacted the Veterinarian listed above and given authorization for them to release information to Kentuckiana Pug Rescue.

Please list the Name, Address, and Telephone Number of your current veterinarian. * If you have no current pets, please list the information for your most recent veterinarian. YOUR APPLICATION WILL NOT BE PROCESSED WITHOUT THIS INFORMATION. You will also need to let your Veterinarian know that Kentuckiana Pug Rescue will be contacting them, and give your Vet authorization to release information to KPR. *

Are you aware of the health problems that Pugs can have?

Are you willing to take care of any health problems that may occur after adoption of your Pug?

Do you know that Pugs shed 365 days a year?

Do you know that Pugs snore?

Pugs can live to be 14+ years old. Are you willing to have a Pug be a part of your life for that amount of time?

What types of behaviors do you expect from your Pug?*

What amount of time and effort do you plan to devote to your Pug each week?

Do you plan to enroll your Pug in obedience class?

What family members will assist in potty training, exercising, and feeding the Pug?*

What is your definition of disciplining a dog?*

Are you aware that Pugs are difficult to house train?

Most rescue dogs do not come housetrained. Are you committed to working with your pug to housetrain them or do you require a fully housetrained pug?

Do you have any training objectives for your Pug?*

What color Pug do you wish to adopt? *
Choose one: Fawn Black No Preference

What age preference do you have for your Pug? ** Notice: We currently have a waiting list for pugs under 5. If you are looking for a pug under 5, you are welcome to fill out an application but please be aware that once approved you will be added to the waiting list. *
Choose one: Less than one year (very rare in rescue) 1-5 years 6+ years No preference

What sex Pug do you prefer to adopt? *
Choose one: Male Female No Preference

Would you adopt a Pug mix?

Would you adopt a bonded pair of Pugs that have been together their entire lives?

Are you willing to financially care for your Pug's health throughout his/her entire lifetime?

Are you willing to have a home visit and interview?

Are you willing to return your Pug to Kentuckiana Pug Rescue should any problems arise that force you to no longer care for your Pug?

Is this Pug for someone else?

Would you be willing to adopt a special needs Pug?

If Yes, please state which special needs you would be willing to accept, for example: Blindness, Deafness, Lameness, On medication full-time, Etc.

Please share any additional information you feel would be helpful to Kentuckiana Pug Rescue:

Reference #1 (Non-Relative) * Name, Address, Phone Number of Non-Relative Reference *

Reference #2 (Non-Relative) * Name, Address, Phone Number of Non-Relative Reference *

Reference #3 * Name, Address, Phone Number of Reference *

How did you learn about Kentuckiana Pug Rescue? *

What is the best method for us to contact you? Example: Phone, Text, Email*