How long have you lived at this address?

*Please indicate which best describes your current living situation:
House Condo Apartment Mobile Home
Rent Own Live with Parents

* If you rent, Name & phone number of Landlord:

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? *Is there a fence?

Why type/brand of dog food are you currently using or will you choose to use?

*What type of fence and how tall? Will gate be locked with a pad- lock?

Is the fence secured underground as well?

*Do you have young children visit on a regular basis? (i.e. grandchildren, babysitting)

 *If yes, Ages:

Affordability

  *To feed, vaccinate, license and provide medical care for this animal, what do you anticipate spending yearly? Select One $200 $300 $400 More

Consider the following costs:
One vet office visit = $35    

annual shots = $20 each x 3    = $ 60.00

necessary annual dental cleaning    = $200.00
+ food, toys, bed, grooming, medication, neutering/spaying, sick dog visit, license, = HUNDREDS of $’s

  *Can you afford to care for a Yorkie? Select One Yes No

  *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? Select One Yes No
 

Adoption Information

*Is someone home during the day?

If no, 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)

If kept outside, will you have a dog run/dog house?

*When you go away for a few days, who will care for the dog?

*Where with the dog sleep at night?

*Do you agree to spay or neuter this dog if it has not been done already?

 Training

Will you go to obedience class and take your dog?

Which trainer do you plan to use?

*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

Do you prefer a male or female or either? Explain your choice:  

Age range?

Weight preference:   

Explain your choice: 

Would you consider a dog with special needs?

Would you consider adopting more than one if they were a bounded pair?
Is there a dog on our web page that you are interested in? Which one?

*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?

Other Pet Information

*Dog you have other pets?

*Type (list breed, age, sex):

*If not have you ever owned a dog before?

*Are your other pets current on all vaccinations?

*Are your other pets spayed/neutered?

*Are your animals on heartworm preventative? What type?

**Veterinarian's Name & 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 Yorkies Inc.

*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:

*List the pets have you owned in the past ten years and what happened to them:

Rescue Knowledge

How did you hear about Yorkies Inc.?

List any Humane Societies, Organizations, Breed or Training Clubs you are associated with:

*What do you know about rescues and dogs in rescue?

*Why do you want to adopt a dog from a rescue/placement service?

What time frame are you looking to adopt? Or how long are you willing to wait for the right match?

*Have you applied to other rescues/shelters etc. for a dog?

If yes, please explain:

Yorkie Knowledge

*We will attempt to provide you with an honest evaluation of temperament on any dog we have to place. Do you realized that often times the complete history of a Yorkie may not be known and you may encounter some behavioral problems?

Are you willing to work with us on correcting these problems?

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?

*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 and  teeth etc. Yorkies with kids or larger pets etc?

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

Space for additional comments:

*I certify that the information provided on this form is true & 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. Home checks are made on a random basis following or prior to adoption. If upon inspection we find that information contained in this application to be false, we retain the right to turn down or remove the animal from your premises without a refund of moneys paid.

*Signature  Date

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"He is your friend, your partner, your defender, your dog. You are his life, his love, his leader. He will be yours faithful and true until the last beat of his heart. You owe it to him to be worthy of such devotion"  - Author Unknown