FIRST and LAST Name

Street Address

City, State, and Zip

Home Phone

Employer

Work Position

Work Phone

E-mail Address

Co-Applicant

Co-Applicant Employer

Co-Applicant Work Position

Co-Applicant Work Phone

Co-Applicant E-Mail

Length of time at current address?

Do you own or rent?

Landlord's name and phone number, if applicable

List ALL members of household; names and ages

Pets in household

1. Name Age
Breed Spayed/Neutered?

2. Name Age
Breed Spayed/Neutered?

3. Name Age
Breed Spayed/Neutered?

Additional pets, including name, age, breed, and if they have been spayed/neutered:

What is your vet's name and phone number?

If any of your pets are not spayed/neutered, please give brief description why.

Describe other pets you've had in the past and why they are no longer living with you:

Have your current/past pets been taken to the vet annually? (Y/N)

If NO, please explain:

Have your current/past pets been vaccinated annually? (Y/N)

If NO, please explain:

Have your current/past pets been heartworm tested yearly and kept on heartworm preventive? (Y/N)

If NO, please explain:

Are you prepared for large vet bills in the future, if necessary? (Y/N)

If NO, please explain:

Are you willing to housebreak or re-housebreak a shar pei? (Y/N)

If NO, please explain:

Are you willing to give a shar pei time to adapt? (Y/N)

If NO, please explain:

Would you consider adopting a shar pei with medical problems? (Y/N)

If NO, please explain:

Would you consider adopting a shar pei with behavioral problems? (Y/N)

If NO, please explain:

Would you keep your adoptive dog for the rest of his/her life? (Y/N)

If NO, please explain:

A home visit is mandatory for all potential adopters. Will this be a problem for you? (Y/N)

If YES, please explain:

What would you do if your shar pei displayed bad behavior?

Where would your shar pei be kept while you are at home?

Where would your shar pei be kept if you are NOT at home?

Where would your shar pei be kept at night?

What hours would your Shar Pei be left alone?

If you move, what would happen to your Shar Pei?

Is your yard fenced? (Y/N)

If YES, what kind of fence do you have?:

If NO, how will potty breaks be handled?

Have you previously owned a Shar Pei? (Y/N)

How did you hear about Shar Pei Savers, Inc. ?

Which Shar Pei Savers’ dogs are you interested in?

What age range would you consider?

Describe your ideal adoptive Shar Pei:


Do you have any additional comments or questions?

By submitting this application, I affirm that I have not been conviced of any crime involving the mistreatment, neglect, or abuse of any animal. I also affirm that I am 18 years of age of older and the above information is true to the best of my knowlege. I also agree and understand that any misrepresentation may result in my suspension as a Shar Pei Savers, Inc. adoptive home.

Please note that we are an all-volunteer organization. Your application will be reviewed as soon as possible, but this process can take up to two weeks. Incomplete applications will delay the process further, so please fill out application thoroughly.