Date: * JanFebMar AprMayJun JulAugSep OctNovDec 12345678910111213141516171819202122232425262728293031 Name: Address: City/State/Zip Contact Phone Number: * E-mail address: * Name of dog you wish to adopt: * Reason for adopting this dog: Are there any children under the age of 18 in your home? * Yes No Do you own or rent your home? * Do you live in an apartment? * Yes No If you rent, does your landlord object to you having dogs? Yes No If you rent, what is your landlord's name and phone number? * How long have you lived in your current home? * If less than 3 years, how long did you live in your previous home? * Do you have a yard for this dog to play in? * Yes No Do you object to a home visit? Yes No How many pets do you currently have in your home? What type of pets are they? How long have you owned these pets? Are they indoor or outdoor pets? * Who is the caretaker of these animals? * Are all the dogs and cats in your home spayed/neutered? * Yes No If not, please explain: * What is your veterinarian's name, address and phone number? * Have you ever surrendered an animal to the animal shelter? * Yes No If yes, please explain: * Have you ever adopted an animal from a rescue group? * If yes, who was the rescue group? * Do you still have this animal (from the rescue group)? * Yes No If no, please explain: * Have you ever been cited for animal cruelty, abuse or abandonment? * Yes No If yes, please explain: Number of adults in your home: * Number and age of children in your home: * What are the ages of the children in your home? * Is anyone in your home allergic to animals? * Yes No If yes, please explain: * Where and how will you house this dog? * Who will be responsible for the daily care of the dog? * How many hours a day will this dog be left alone? * Who will care for the dog when you go on vacations and trips? * What will you do with this dog if you have to move? * Have you owned any other dogs in the last 5 years not listed on this application? * Yes No What happened to these animals? * Name and phone number of 3 references we may contact: * I understand this application is for screening purposes and does not guarantee I will be approved to adopt. * Yes No I am willing to commit long-term to the care of this dog * Yes No If I am no longer able to care for the dog I will return the dog to the Oklahoma Chihuahua Rescue. * All answers on this application are truthful and accurate. * Yes No |WELCOME| |HOW TO ADOPT| |ADOPTION APPLICATION| |FOR ADOPTION|