CHOW CHOW RESCUE & ADOPTION APPLICATION

Please select this entire document (Ctrl+a), copy (Ctrl+c) and paste (Ctrl+v) this completed form into an email and return it to c2chows@gmail.com.  Once we have reviewed your application, a representative will contact you.

Personal Information
Your Name:
Your Age:
Spouse's Name:
Spouse's Age:
Street Address:
City, State & Zip:
Home Phone:
Cell Phone:
Email:
Employer:
Phone:
Spouse Employer:
Phone:

Reference Information
You must include a vet reference and two personal references to be eligible for consideration.
(PLEASE CALL YOUR VET'S OFFICE TO AUTHORIZE RELEASE OF INFO ABOUT YOUR PET CARE HISTORY TO CHOW RESCUE.)
Vet Name:
Vet Phone:
Date of Last Visit:

Personal References should NOT include family members.
Reference 1 Name:
Phone:
Email:
Reference 2 Name:
Phone:
Email:

Environment
Number of Children:   Ages:
Please list the Names, Ages and relationship of anyone living in your household is not listed above:
1) Name:                Age:                  Relationship:  
2) Name:                Age:                  Relationship: 
3) Name:                Age:                  Relationship: 
4) Name:                Age:                  Relationship: 
5) Name:                Age:                  Relationship: 

Is everyone in your household in agreement to adopt a Chow?  Yes or No 
How long have you lived at this address?
Describe your current living situation:  House, Apartment, Mobile Home, Condo
Do you?  Rent, Own, Live with Parents
What type of environment?  City, Suburban, Country
Is there a Yard?  Yes or No
Fence?  Yes or No
If "Yes" to Fence, what type and how tall?                        
Locked Gate?  Yes	or No
Do you have a swimming pool?  Yes or No
If "Yes" to pool, what type?  In-Ground, Over-Ground
How many hours would the dog be left alone during the day?
Where would the dog be kept while you were working?

ADOPTION INFORMATION
Why do you want a Chow?
Where will the dog spend most of its time?
Have you ever owned a Chow?  Yes or No
Sex Preference:  Male, Female, Doesn't Matter   
Age Preference: Puppy 0-6 months, Adolescent 1-2 yr's, Adult 2+, Doesn't Matter
If interested in a specific dog, please provide it's name: 
Previous & Current Pet Information
Please list ALL current Pets (Name, Age, Breed, Gender).
  Name:              Age:		Breed:		Gender (M/F):
1)
2)
3)
4)
Are your pets Spayed/Neutered?  Yes	or No
Current on all vaccinations?  Yes or No 
Taking YEAR ROUND Heartworm Preventative?  Yes or No 
Please list the pets you've owned in the last 3 yrs who are not listed above, what happened to these pets and why? (Ex: Fluffy, Poodle, Female, passed away at 10 of old age)
1)
2)
3)
4)

CERTIFICATION
Please read the following very carefully. By submitting this adoption application you hereby certify that all the above information is true and correct and agree to the following terms and conditions to be considered for the adoption of a rescued Chow.

I.  I understand that the previous history and/or heritage of any particular dog is unknown prior to them being accepted into foster care by Chow Rescue.

II. I understand that I will be required to attend formal obedience training with any dog adopted from Chow Rescue.

III. I understand that I will be required to keep a collar with a license and rabies tag on any dog adopted from Chow Rescue at all times.

IV. I understand that providing any false or misleading information on this application will result in immediate denial of my application.

V. I understand that if I am approved for adoption I may state a preference in dog choice but that the final decision as to what dog I will be allowed to adopt is that of Chow Rescue and I agree to adhere to their advice.

VI. I understand that Chow Rescue is under NO obligation to approve my application and reserves the right to deny ANY application without cause or reason.

VII. I am 21 yrs. of age or older financially and emotionally capable of caring for, training, and providing a stable environment for a rescued Chow.

VIII. I understand that there is an adoption donation and that this donation goes directly to provide care for the rescued chow's within Chow Rescue's foster program and that 30 days after the adoption date this is a Non-Refundable donation.

Date Submitted:  ___/___/_____