First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone

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 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. *

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

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 you have no fence, how will you ensure that your foster pug will safely 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?

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?*
Choose one: Confined to a certain area of the house Crate Free run of the house Garage Indoors with dog door Yard

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?

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. *

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

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

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 know that Pugs shed 365 days a year?

Do you know that Pugs snore?

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 have a home visit and interview?

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.

Do you have any experience with the following? (ONLY check those that you would be willing to encounter with a foster pug.)

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 to contact you?