PUG RESCUE OF PENNSYLVANIA INC.
                         ADOPTION APPLICATION
To e-mail your application:
Type in this file to complete your application, save it, and attach it to an e-mail. Mail to

To mail your application:
Print completed form and mail to:
Pug Rescue of Pennsylvania Inc., RR#2 Box 2394, Cresco, PA 18326

Name: _______________________________________________________
Address: ______________________________________________________
City: ________________________________ State: PA Zip:____________
How long have you lived at this address:_____________________________
Home Phone: ___________________ Cell Phone:_____________________
Work Phone:____________________ E-Mail:________________________
Hours worked per day:________ Occupation/Profession:________________
Age:___20’s ___30’s ___40’s ___50’s ___60’s ___70’s

Cell Phone:____________________ Work Phone:_____________________
Hours worked per day: _______ Occupation/Profession_________________
Age: ___ 20’s ___30’s ___40’s ___50’s ___60’s ___70’s

Number of adults living in the home: _________
Number and age of children living in the home:_______________________

Do you: Own your home: Yes___ No___ Rent your home: Yes___ No___
Do you live in a: House___ Condo___ Apartment___
Yes___ No___ Do you live on/near water?
Yes___ No___ Does anyone in the home smoke?
Yes___ No___ Are you a United States Citizen?
Yes___ No___ Have any of the applicants ever been cited or fined for
                animal related offenses?
Yes___ No___ Have you ever been denied adoption from another rescue
                group or shelter?
Yes___ No___ Does anyone in your home not want a pug?
       If yes, explain:___________________________________________

Yes___ No___ As the person filling out this application, are you the
             primary care giver?
Yes___ No___ Are you physically able to take care of a pug?
Yes___ No___ Do you have and use air conditioning?

Yes___ No___ Are you willing to administer daily eye drops and/or
                 medication to the pug if needed?
 Yes___ No___ Are you willing to adopt a special needs pug?
  If open to special needs, check which special needs you would accept:
    Blind___ Deaf___ Diabetic___ Epileptic___ Arthritis___
    Allergies___ Daily Medications___ Incontinent___ Back Issues___
    Can’t Climb Stairs___
Yes___ No___ Do you authorize Pug Rescue of PA to contact your veterinarian as a
                Current vet and phone number:
Yes___ No___ Do you currently own a pug(s) If yes, how many:________
Yes___ No___ Does your pug have any physical problems?
Yes___ No___ Dominance issues?
Yes___ No___ Does your pug get along with other dogs?
Yes___ No___ Do you have another breed of dog living with you now? If
                 Yes, how many: _________
           What breeds:__________________________________________
Describe each personality: Active___ Mellow___ Alpha___ Age___ Sex___
                            Active___ Mellow___ Alpha___ Age___ Sex___
                            Active___ Mellow___ Alpha___ Age___ Sex___
Yes___ No___ Do you have a cat or cats? If yes, how many:_____
Yes___ No___ Are they all declawed? Are they pug friendly?________
Yes___ No___ Do you have another type of animal living with you?
   What species:________________________________________________.
 Where did you get your animals: ____Breeder ____Pet Store ____Rescue
                        _____Shelter _____Stray
Have you owned dogs in the last 10 years:___________________________.
What happened to them:_________________________________________.
Yes___ No___ Have you ever had an animal euthanized?
If yes, explain:_________________________________________________
Yes___ No___ Have you ever taken an animal to a shelter or released an
                 animal to a third party?
Yes___ No___ Can you deal with a pug that snores?
Yes___ No___ Can you deal with a pug that scratches to communicate?
Yes___ No___ Can you deal with a pug that may bark a lot?
Yes___ No___ Can you deal with a pug that has accidents or may become
Yes___ No___ Can you deal with a pug that licks?
Yes___ No___ Can you deal with a pug that sheds a lot (because they all do)

Yes___ No___ Are all of your current dogs and/of cats spayed or neutered?
Yes___ No___ Are all of your dogs and cats current on vaccinations?
Yes___ No___ When you walk your pug/dog, do you use a leash?
What type of pug are you willing to adopt:
 ___Fawn            ___Male             ___ (1-2 years) ___Active
 ___Black            ___Female          ___ (3-5 years) ___Mellow
 ___No preference ___No preference ___(6-8 years) ___Special Needs
                                        ___(9+ years)      ___No preference
                                        ___ No preference
Yes___ No___ Are you open to adopting a pug mix?
Yes___ No___ Do you have a pool or spa? Yes___ No___ Is it covered or
               fenced in?
Yes___ No___ Do you have a yard? Yes___ No___ Is it fenced in?
Yes___ No___ Would you object to a Pug Rescue of PA representative
               calling to see how you and the pug are doing?
Yes___ No___ Would you object to a home visit by a representative of Pug
                Rescue of PA as part of the application process?
Yes___ No___ Do you travel on business? If yes, how often?____________
Yes___ No___ If you rent, do you have permission to keep a dog in the
              home? Landlord’s name:____________________________
Landlord’s Phone Number:___________________________________
Yes___ No___ Pesticides, slug/snail pellets and other chemicals such as
              antifreeze are toxic. Do you agree to store such items so that
              a pug cannot get to them?

Explain under what circumstances would you justify surrendering a pug?

Where will you keep your pug during the day?____________________
Where will the pug sleep at night?_____________________________
Where do other animals sleep?_____________________________________
How many hours a day, on average, will the pug be alone?_________
Where will you pug stay when you are out of town?____________________
Is there anything else you feel we should know about you, your pets or your

Can you afford to care for a dog? _______________________________

What do you know/like about the pug breed?_______________________
Why do you want a pug? ________________________________________.
List three personal references and telephone numbers (no relatives). All will be contacted.
1.Name:___________________________ Phone:_____________________
2.Name:___________________________ Phone:_____________________
3.Name:___________________________ Phone:_____________________

Thank you for taking the time to complete this application. Your answers will help us
effectively match an available pug’s needs with your lifestyle and requirements

To adopt a pug from Pug Rescue of Pennsylvania, adopters must have an extremely high
level of commitment to their pug. It is a responsibility for the life of the dog, whether sick
or well, young or old (average life span is 14 -16 years). If you are unable to keep this
commitment, you must agree to return the dog to Pug Rescue of Pennsylvania Inc.

  (Spouse/Partner must also sign)
Signature ____________________________________date:___________
Signature ____________________________________date:___________

Pug Rescue of Pennsylvania reserves the right to refuse any application.

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