NASPR ADOPTION APPLICATION
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Name:*required

Street Address:*

City:*State:*Zip:*

Home Phone:* Work Phone:   

Email Address (REQUIRED):*

Applicant’s Employer: 

Position:  

Phone: 

Co-Applicant’s employer: 

Position:  

Phone: 

 

1) How did you hear about NASPR (North American Shar-Pei Rescue                                                        Select One Internet Search Referral From Someone Else Advertisement in Paper 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? Select one Own Rent

6) What type of home do you currently live in?                                                        Select one 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   Select One Yes No

11)If other adults in the household, do they all approve of getting a dog   Select One Yes No

12) Have you ever owned a Chinese Shar-Pei? Select One Yes No

13)Do you understand this dog will stay with you for the rest of his life?                                                        Select One Yes No

14)If you have other animals, please fill out the section below:
  Select one None Dog Cat Other Breed: Age: Select One Under One Year 1year to 3 years 3 years to 5 years 5 years to 7 years Over 7 Years Spayed/Neutered? Select One Yes No

Select one None Dog Cat Other Breed: Age: Select One Under One Year 1year to 3 years 3 years to 5 years 5 years to 7 years Over 7 Years Spayed/Neutered? Select One not applicable Yes No

15)If you have owned animals in the past, what happened to those animals?
  Select One 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?                                                          Select One Yes No

17) Are your current pets current on their vaccinations and heartworm preventative (where applicable)? Select One N/A Yes No

18) Are you familiar with heartworm preventative and the vaccinations that are necessary?
  Select One 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? Select One Yes No

24) What kind of fencing do you have? Select One 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?                                                         Select One Yes No

27) Where do you plan on keeping your Chinese Shar-Pei the MAJORITY of the time?                                                        Select One Inside Outside Garage Basement Other
If other, please indicate

28) Where will your Chinese Shar-Pei sleep at night? Select One 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? Select One 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