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Southern Belle Chihuahua Rescue Adoption Application

This donation button is for Southern Belle Chihuahua Rescue Of Alabama. Any other donation button on this website is for donations to Second Chance Chi. If you are donating to Southern Belle Chihuahua Rescue Of Alabama use this button.

Southern Belle Chihuahua Rescue Online Adoption App

Contact Information

Name

First

Last

Address

Street Address City State / Province / Region Postal / Zip Code Country

Daytime Phone

Evening Phone

Best Time To Call

Morning

Afternoon

Evening

other

Your EmailREQUIRED

Occupation

Family And Home Members

Spouse Name

First

Last

Spouse Occupation

Children

Yes

No

If Yes How Many/Old

Roommates

Yes

No

If Yes How Many/Age

Residence Information

A letter from your landlord or apartment manager may be required if you rent.

Time At Address

Own/Rent

Own

Rent

Type Of Residence

House

Condo/Townhouse

Apartment

Mobile Home

If You Rent, Does Your Landlord Allow Pets

Yes

No

I Dont Know

Landlord's Name

First

Last

Landlords Phone

Describe Household

Active

Noisy

Quiet

Average

Does anyone in the family have pet allergies

Yes

No

If Yes, Please Explain

Is everyone in agreement with the decision to adopt a dog

Yes

No

If No, Please Explain

Do you have time to provide adequate love and attention

Yes

No

If No. Please Explain

Other Pets

List current pets one on each line. . . . Example: ( Name, Sex, Age, Breed )

What other pets do you have (specify type and how many)

Are these pets up to date on vaccines

Yes

No

If No: Please Explain

Are these pets spayed or neutered

Yes

No

If No; Please Explain

Have you ever surrendered a pet to a shelter

Yes

No

If Yes. Please Explain

Have you ever had a pet or animal euthanized

Yes

No

If Yes: Please Explain

Veterinarian Information

We will check all veterinarian references!!

Do you have a regular veterinarian

Yes

No

If No Please Explain

Veterinarian’s Name

First

Last

Clinic Name

Clinic Street Address

Street Address City State / Province / Region Postal / Zip Code Country

Clinic Phone Number

(Providing SBCRA with this information you are allowing SBCRA to call your vet. Please call your vet and ask them to authorize the release of information to SBCRA.)

Personal References

Where will the dog spend the day? (describe)

Reference One

Name:

First

Last

Address, Not Required

Street Address City State / Province / Region Postal / Zip Code Country

Phone: Number

Relationship (relative, neighbor, friend, etc.)

Reference Two

Name,

First

Last

Address: Not Required

Street Address City State / Province / Region Postal / Zip Code Country

Phone;

Relationship (relative, neighbor, friend, etc)

About the Dog You Wish to Adopt

Where will the dog spend the night? (describe)

Who will have financial responsibility for this dog

Number of hours (average) dog will spend alone and why?

When the dog goes out, how do you plan to supervise it? (explain)

Who will have primary responsibility for this dog's daily care?

Agreement

Do you agree to provide regular health care by a Licensed Veterinarian?

Yes

No

Do you agree to keep the dog as an indoor dog?

Yes

No

Do you agree to contact SBCRA if you can no longer keep this dog?

Yes

No

Are you willing to let a representative of SBCRA visit your home by appointment?

Yes

No

If you adopt one of SBCRA dogs, do you agree to update me with photos for at least six months?

Yes

No

If you adopt one of SBCRA dogs, do you agree to never rehome the dog, and to return him or her to me if for any reason you are unable to keep him or her?

Yes

No

Do you agree that any and all funds placed on a animal for adoption is not refundable for a animal returned that is no longer wanted or able to keep.

Yes

No

If you adopt one of SBCRA dogs, do you agree to give me complete access to the dog's records with the veterinarian responsible for the care of the dog?

Yes

No

If you adopt one of SBCRA dogs that is too young to be spayed/neutered at time of adoption do you agree to get it spayed/neutered when it reaches the appropriate age and contact us with the information?

Yes

No

You agree that SBCRA may take the dog back or ask for its surrender if the dog is not getting the care that is agreed upon by our adoption terms.

Yes

No

If no to any of the above questions, please explain here!!

This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian. By signing i attest that all of the information I have given is true and complete to the best of my knowledge.

Sign HereREQUIRED

First

Last

Date SignedREQUIRED

Co-applicant Sign Here

First

Last

Date Co-applicant Signed

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