Pug Rescue Victoria - Application Form

Application To Adopt A Pug

Please note: Incomplete application forms will not be considered.

Name (and age):
Address:
Home Phone:
Work Phone:
Mobile:
Email:
How did you hear about Pug Rescue Victoria?
If you are interested in a certain pug that you have seen on the website, please specify which one:
Your preference:
Colour:
Age:
Number of Pugs:
	Please note: We rarely get puppies into the rescue, so if you have your heart set on a puppy, you are best going through a reputable breeder. (Pug Club of Victoria)
Why have you decided on the pug breed?
Are you employed?
How many adults live in your household?
How many children live with you? (include ages)
How many hours a day will your pug be home alone?
Do you have other pets?
If yes, please specify type/breed/sex and whether desexed:
	Please note: Pugs will only be re-homed in homes where all other dogs in the household are desexed.
Would you consider adopting a Pug who has sustained an injury or who suffers from an existing illness/disability?
	Think about your answer carefull. Can you afford to? Could you deal with the heartbreak if he/she did not live long? However, this can be a very rewarding experience, knowing you have given this little darling a last chance at real love and happiness.
Would you consider a cross breed Pug?
Previously have you ever owned a Pug?
If not a previous owner of a Pug what is your knowledge of the breed:
If a previous dog owner (any breed), how long did you own this dog?
Where is this dog now?
If re-homed/surrendered to shelter, please elaborate:
In your opinion, which of the following circumstances justifies surrendering a pet? (you may tick one or more)	Moving House Personality clash with your other pets Escaping from your yard Children lost interest and no longer take responsibility Too time consuming Ongoing medical problems Fears for the safety of your new baby Divorce / Break-up Coat shedding (Pugs shed 365 days/yr) Financial problems Toilet training problems Excessive barking Destructive behaviour Fear of pet being lonely while you're not home
Other, please specify:
Your home:
Do you:
	If you are renting, you will need to supply evidence from your landlord allowing you to have a pug on the premises.
Do you have secure fencing?
Approximate size of fenced area:
Do you have a pergola/shade in the backyard?
	Pugs do not tolerate extreme heat or cold, therefore need some protection when outside.
Do you have a doggy door?
If not, would you be prepared to install one if you were able to adopt a pug from the rescue?
How many rooms in your home are air conditioned?
Is your motor vehicle air conditioned?
Do you have a pool?
Is it Pug-proof?
	Majority of pugs cannot swim and will drown very quickly. If you do not have a secure fence around your pool, your application will not be considered.
Where will your new pug sleep?
Do you pledge to allow your Pug full access to indoors?
Do you pledge to have your Pug vaccinated, wormed and heart-wormed at the required intervals?
Do you pledge to purchase products which will keep your Pug flea-free?
Do you pledge to return your Pug to us if you encounter any difficulty?
Do you pledge to love and care for your Pug and consider his/her needs to be of supreme importance?
Would you agree to allow us to visit you at your home prior to adoption?
Would you agree to an occasional phone call from us to inquire about his/her well-being?
Tell us why you would be the perfect forever home for one of our rescue pugs:
	I the undersigned, confirm that I have read and clearly understand all of the information given within this form I, the undersigned, realise the commitment I am making to my Pug and agree to honour all Pledges made within this application.
Your signature: (type full name)
Date:
Name and telephone number of your usual veterinarian:
Name and contact numbers of two (2) personal referees:
	I hearby agree to relinquish my Pug if it is established that I have given any false or misleading information on my Application OR, if allegations of abuse or neglect are reorted to PUG RESCUE VICTORIA or any other animal welfare agency.
Your name: (type full name)

PLEASE BE ADVISED:
PUG RESCUE VICTORIA reserves the right to seize the Pug from your property post-adoption if it is established you have given false or misleading information in your Application OR, if allegations of neglect or abuse are reported to us or any other animal welfare agency.

NOTE:
Filling out an application form does not guarantee you a pug from Pug Rescue Victoria