Yorkie Rescue Colorado

Adoption Application

NOTE: All fields with * are required information. Applications missing this information will be deleted.

Basic Information

*Name:	*Age:	*Spouse/partner Name:	*Age:
*Address:	*City:	*State:	*ZIP:
*E-Mail Address:	*Home Phone:
*Your Employer:	*Work Phone:	*Work Hours:
*Spouse's/Partner's Employer:	*Work Phone:	*Work Hours:
*Do you or your spouse/partner work from home?	*Number of Children:	*Their ages:

*Are you expecting, or are you planning a family in the future?	*Is everyone in your household in agreement on adopting a Yorkshire Terrier?	*Why do you want a Yorkie?
What activities do you plan to do with your Yorkie?	How many years do you plan to keep the dog?	*Under what circumstances would you give up your dog?
Have you ever given up a dog or taken a pet of your own to a shelter?	*How much research have you done about the Yorkie breed? (Books, Internet, talked to breeders, visited dog shows, etc.)	*What do you know about Yorkies as far as health issues, grooming, teeth, etc? Yorkies with kids or larger pets, etc?

Affordability

*To feed, vaccinate, license and
  provide medical care for this
  animal, what do you
  anticipate spending yearly?

Consider the following costs:
One vet office visit = $40, annual shots = $20 each x 3 = $60, necessary annual dental cleaning = $200 + food, toys, bed, grooming, medication, neutering/spaying, sick dog visit, and license = HUNDREDS of $'s.

*Can you afford to care for a
Yorkie?

*If you adopted a Yorkie and it developed a
medical problem that was costly ($1000+)
but correctable, what would you do?

*Are you willing and prepared to
  deal with potential medical
  problems and/or special needs
  should they arise in the future?

Your Home

How long have you lived at this address?	*If you rent, please provide the name & phone number of your Landlord:	*Please indicate which best describes your current living situation:
What type of environment? City Suburban Country	If less than two years, please list your previous address:	*Besides your immediate family, are there others residing in your home?

*Names:	*Ages:	*Does your home have a: Yard Fence
What type of fence and how tall?	*Do you have young children visit on a regular basis (i.e. grandchildren, babysitting)?	*If so, please list their ages:

Adoption Information

*Is someone home during the day?	*If not, where will the dog stay while you are gone?
*Where will your dog be kept most of the time? In house Outside Basement Other (specify):	*When you go away for a few days, who will care for the dog?	*Where will the dog sleep at night?

Training

Will you take the dog to obedience class?	*Have you ever owned a Yorkie?	Where is that Yorkie now?
What is your method of discipline for your dog?	What would your reaction be if you came home to an "accident" in the house?

Preferences

Male
Female

Would you consider a dog with
special needs?

Would you consider adopting
more than one if they were a
bonded pair?

Other Pet Information

*Do you have other pets?
Yes
No

*Type (list breed, age, sex):

*If not, have you ever owned
a dog before?
Yes
No

*Are your other pets current
on all vaccinations?
Yes
No

*Are your other pets
spayed/neutered?
Yes
No

*Are your animals on heartworm
preventative?
Yes
No

What brand?

*Veterinarian's Name:

*Veterinarian's Phone Number:

NOTE: We will be calling your Vet. Please be sure to call them and give them the "ok" to release your information to Yorkie Rescue Colorado.

*Name that animals are under at the vet's office (pet's name and owner's name):	If applicable, approximate date of your current pet's last office visit and why:	*List the pets you have owned in the past ten years and what happened to them:
*We attempt to provide you with an honest evaluation of temperament on any dog we have to place. Do you realize that often times the complete history of a rescued Yorkie may not be known and you may encounter some behavioral problems?	Are you willing to work with us on correcting these problems? Yes No	How long would you allow for an adopted dog to adjust to you, your family and home (if any)? What would you do after that period of time?

*Please provide the name, address and phone number of three references:

Name	Address	Phone Number



Additional Comments:

*I certify that the information provided on this form is true and correct. I am also financially and physically able to care for this animal. I understand that proper food and veterinarian care may be costly, and I am able to meet these requirements. If for any reason I decide to relinquish this animal, I will contact YRC and return the dog to a YRC representative. I understand that this is a rescued dog and the medical history may be incomplete. I am adopting this dog, knowing that it may have medical or behavioral problems which are unknown to Yorkie Rescue Colorado.

*Signature: ___________________________________________________________________________ Date: _

If you are applying for a specific dog and he is a better match for another person, would you like to have your application kept on file in case another, who is a better match for you, becomes available?

Yes _____________ No _____________

Home visits are made prior to adoption. If we find that information contained in this application to be false, we retain the right to refuse your application for adoption.

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