1) How did you hear about NASPR (North American Shar-Pei Rescue
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Internet Search
Referral From Someone Else
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Booth at Show/Festival
Other
If other, please indicate
2) What do you know about Chinese Shar-Pei (temperament, health, etc)?
3) Why do you want to adopt a Chinese Shar-Pei? Please give all reasons
that apply (companion, guard dog, gift, to breed, personal protection, for
children, other). Do you have a preference (coat, color, sex, age)
4) How long have you lived at the above address?
5) Do you rent or own your current home?
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Own
Rent
6) What type of home do you currently live in?
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Single family home
Condo
Townhouse
Apartment
Mobile Home
7) If you rent, please provide us with your landlord's name and phone
number.
Please note that we will contact your landlord.
8)If you move to a location that does not accept dogs, what will you do?
9) If you have children living in your home or that visit on a regular
basis, please indicate their name, sex, and age(s).
10)Are there other adults in the household
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Yes
No
11)If other adults in the household, do they all approve of getting a dog
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Yes
No
12) Have you ever owned a Chinese Shar-Pei?
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Yes
No
13)Do you understand this dog will stay with you for the rest of his
life?
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Yes
No
14)If you have other animals, please fill out the section below:
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None
Dog
Cat
Other
Breed: Age:
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Under One Year
1year to 3 years
3 years to 5 years
5 years to 7 years
Over 7 Years
Spayed/Neutered?
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Yes
No
Select one
None
Dog
Cat
Other
Breed: Age:
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Under One Year
1year to 3 years
3 years to 5 years
5 years to 7 years
Over 7 Years
Spayed/Neutered?
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not applicable
Yes
No
15)If you have owned animals in the past, what happened to those animals?
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Never owned
Put to Sleep Because of Health
Put to Sleep Because of Old Age
Put to Sleep Because of Behavior
Ran Away/Stolen
Accident/Hit By Car
Given Away to Family Member/Neighbor/Friend
Given Away to Stranger
Taken to Animal Control/Humane Assoc.
Turned In To Breed Rescue
16)Do you take your pet to a vet annually?
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Yes
No
17) Are your current pets current on their vaccinations and heartworm
preventative (where applicable)?
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N/A
Yes
No
18) Are you familiar with heartworm preventative and the vaccinations
that are necessary?
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Yes
No
19) We require that all animals adopted from us be spayed/neutered. If
you have any questions/concerns/reservations about this policy, please
explain below.
20)Are you prepared for the possibility of more than routine vet bills
and care of the dog?
Select One
Yes
No
21)If you have animals in the house that are not spayed/neutered, fully
vaccinated, and on heartworm/flea prevention medicine - please explain.
22) Please provide us with the name/address/phone number of your
veterinarian. We will call them for a reference.
23) Do you have a fenced yard?
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Yes
No
24) What kind of fencing do you have?
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None
4 ft. Chain Link
5 ft. Chain Link
6 ft Chain Link
4 ft. Privacy Fence
6 ft. Privacy Fence
Chain Link/Privacy Combo
Invisible Fencing
Electric Fence
Dog Kennel
Chicken Wire/Cattle Fence
Other
25) If you DO NOT have a fence, how will your Shar-Pei be exercised and
go to the bathroom?
Select One
N/A
Paper-Train
Turn Loose Outside
Leash Walks
Other
If other, please indicate
26)Would you allow a home visit by a volunteer on behalf of NASPR?
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Yes
No
27) Where do you plan on keeping your Chinese Shar-Pei the MAJORITY of
the time?
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Inside
Outside
Garage
Basement
Other
If other, please indicate
28) Where will your Chinese Shar-Pei sleep at night?
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Inside
Outside
Garage
Basement
Other
If other, please indicate
29) What will you do with your Chinese Shar-Pei where there is no one at
home?
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Inside
Outside
Garage
Basement
Crate/Cage
Other
If other, please indicate
30) What will you do if your Chinese Shar-Pei exhibits bad behavior? ie..being destructive, soiling the house, barking, etc.
31) Do you understand that this dog may not be housebroken and are you
willing to take the time to properly housetrain?
Select One
Yes
No
32) Do you understand that it may take this dog time (at least 30 days)
to adapt to his new environment and family?
Select One
Yes
No
33) What are your preferences for your adopted dog? ie..age, sex, color,
etc.
34) Would you be willing to adopt a dog with a medical condition
(allergies, thyroid problem, etc). Note..we will not adopt out a dog with a
major medical problem such as cancer.
Select One
Yes
No
Maybe
35) Would you be willing to adopt a dog with a behavior problem (chewing,
separation anxiety, fear of thunderstorms, not housebroken, etc.) Note..we
will not adopt a dog that is aggressive or has bitten before--under ANY
circumstances.
Select One
Yes
No
Maybe
36)Did you see a particular dog on our website that you are interested
in? If so, please indicate in the below space the State and/or regions
37)Please give 2 professional references.
38) Please write any additional comments below. Use this space to also
indicate any health or behavior problems that you could NOT handle (dog
aggression, cat aggression, daily medication,etc.)
By submitting this form you acknowledge and agree to
the terms below:
Adoptee being of lawful age, do now release,
acquit and forever discharge NASPR, its Agents and Assigns, from any and
all actions, claims, demands or damages accruing to me resulting from any
known or unknown injury, loss or damage, sustained by me as a result
of acting as a NASPR adopter.
I
ACKNOWLEDGE THAT ALL THE INFORMATION CONTAINED ON THIS FORM IS TRUE AND
CORRECT. I UNDERSTAND THAT ANY
MISREPRESENTATIONS OF FACT MAY RESULT IN THE REMOVAL OF THE DOG
FROM MY HOME