Name:
Street Address:
City, State, Zip
Home Telephone:
Cell:
Email:
Best time to call:
Please provide the names and ages of all children living in your home.
Please list the ages of any other children who visit frequently.
Please provide the names, ages, and relationship of any other members of your household.
Please list all other pets in your household including breed, age, and gender.
Have you owned a dog before? Please provide details including breed and gender.
Have you owned a pug before? Please provide details.
Do you have a fenced in yard? If so, what type of fence and how large is the fenced in area?
Who will be home with your pug during the day? If you work how much time will the pugs spend alone each day?
Male
Female
No Preference
What gender pug do you want to adopt?
Fawn
Black
No Preference
What color pug do you want to adopt?
Less than 2 years old
2 - 5 years old
5 - 8 years old
8 - 10 years old
Senior
Up to what age are you willing to adopt? You may choose more than one selection.
Yes
No
Open to discussion
Would you consider adopting a special needs pug?
Yes
No
Possibly
Would you be interested in adopting more than one pug at at time?
Own
Rent
Other
Do you rent or own your home? If you rent you will be required to provide a letter from your landlord stating you are allowed to have a dog.
How long have you lived at your present address?
Yes
No
Not sure
Are you planning to move within the next 6 months?
Swimming pool
Air conditioning - central
Air conditioning - window units
Does your home have any of the following? Please check all that apply.
Where will your pug sleep at night?
Where will you keep your pug when you are not at home?
Yes
No
Will you keep your pug indoors at all times unless you are outside with him?
Does everyone in your home agree to adopting a pug?
Yes
No
Does anyone in your home suffer from allergies? If yes, please provide details.
How will you react if your pug behaves inappropriately such as chewing, inappropriate barking, or going to the bathroom in the house?
What will you do if your new pug does not get along with your other pets?
How long of an adjustment period will you allow?
Are you prepared to spend money on your Pug's health care?
Do you realize that owning a pug is a lifelong commitment and that your pug may be costly over the course of its life?
Is there any other information that might influence PRoNE's decision to adopt a Pug to you?
Please provide the name, address, and telephone number of our vet.
Please provide the name, relationship, and telephone number of 3 personal references.
Reference #1
Reference #2
Reference #1