TLC Chow Rescue

Adoption Application

Pet ownership is a serious commitment that the entire household needs to consider
and agree to before the animal is adopted. We want to ensure that each adoptive
household is aware of, and willing and able to accept the physical and financial
responsibilities of pet ownership. Not everyone who wants to own a pet is ready to
properly care for one.

This application will help both you and us to determine if the Chow is the right breed
for you. The questions address various aspects of dog ownership that should be
given serious consideration before you decide to share your life with any dog. Your
answers will help us assess your suitability as a home for a Chow, and to match a
dog to your particular lifestyle. Please be a specific as possible, and answer all
questions as completely and truthfully as you can. Thank you for your interest.

When an application is approved and
requires a minimum adoption fee of
placement. This money helps pay for
spay/neutering of the rescued Chow,
Chow Rescue.
a placement agreed upon, TLC Chow Rescue
$185.00. This may be paid at the time of
the costs of providing health care, shots, and
replacing some of the money spent by the TLC

Any Chow 6 months or older will be spayed/neutered before being placed for
adoption.
Any person(s) adopting a Chow younger than 6 months will be required to sign a
spay/neuter contract.

You and Your Family

Adopters Name___________________________________________

Other Adult(s) at Residence_________________________________

Street Address_______________________________________

City_______________ State_____ Zip__________

How long at this address? ______

Telephone Number: Home: ______________ Work:____________

Are you 21 years or older? ________ (proof may be requested)

Married: _____ Single: _____ Age: _____ (if living with parents)

Number of children living in the home: ________

Ages: ______________________________________________

Does anyone in your household have allergies to animals? _____________________

If yes, to what kinds of animals? _________________________________________

Who will be primarily responsible for the dog’s care and training?
___________________________________________________________________

Preferences

Please check any preferences. (Please note that the age of rescues from animal
shelters are approximate and cannot be verified.)

Male  Female  No preference

 Puppy  Adult  No preference
 Purebred  Chow mix  No preference

Any other preferences? ________________________________________________

Be aware that if your preference is a puppy, we rarely get puppies. When we do

they normally go to families who have previously adopted a Chow from us or have
owned a Chow in the past and have exhibited the ability to properly raise and work
with a Chow.

Are you willing to consider a dog:

 with special medical needs
 who was abused or neglected and need extra love and
attention
 with behavior problems that may require special training?

How long are you willing to wait for a Chow? ___

Why A Chow?

Why do you want a rescued chow? _______________________________________

___________________________________________________________________
___________________________________________________________________

What attracted you to the Chow? ________________________________________

___________________________________________________________________
___________________________________________________________________

How would you describe the ideal dog for you and your family? _______________
___________________________________________________________________
___________________________________________________________________

Have you and your family discussed the pros and cons of owning a Chow?

___________________________________________________________________
___________________________________________________________________
What concerns do you have about this breed?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Are you familiar with the temperament and characteristics of this breed?
___________________________________________________________________
___________________________________________________________________

Please explain your experience and understanding of this

breed.______________________________________________________________
___________________________________________________________________
___________________________________________________________________
________

Please check all of the following that would apply to your new dog:

Watch Dog: ________ Companion: ________ Hunting Dog: ________

Guard Dog: ________ Family Pet: ________
Other (explain): __________________________________________________________

Pet Ownership

Animals can be very expensive to care for (estimated average annual cost $500 for one
dog). Are you willing and able to provide adequate food, shelter, and medical care,
including yearly checkups and vaccinations for an adopted animal?
_______________________________________________________________________
_

Have you ever owned a dog before?_______________________________________

What happened to your last dog? Tell us about that dog:______________________

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Please list all the animals that currently live in your household:

Type/Breed Sex Spayed/Neutered Age Years Owned Where is it kept?

_______ ____ ______________ ____ __________ _____________
________ ____ _____________ ____ __________ _____________

________ ___ _____________ ___ _________ _____________

________ ___ _____________ ___ _________ _____________

How will you introduce and integrate your new Chow with your existing pets?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

What will you do if your newly adopted Chow does not get along with your other pets
for a while? _______________________________
___________________________________________________________________
___________________________________________________________________
________________

Are the other pets current on their vaccinations? ____________________________

References

Please provide at least three (3) names as references, including your landlord (if you
rent your home), and your veterinarian (required reference), groomer, or dog trainer
(if you have one). Other references could include a neighbor, employer, a friend or
relative who owns a Chow, etc.

Name Phone Number Relationship to Applicant

____________ __________________
____________________
________________ __________________
____________________
___________ __________________
____________________

Your Home

Which of the following best describes your current residence:

 Own a single family home  Rent/Lease a single family home
 Rent an apartment  Other

If you rent or lease, is your Landlord agreeable to you owning a dog?

___________________________________________________________________
(Proof of permission is required before an adoption can be finalized.)

If the dog is outside other than for supervised activities, describe what shelter would
be available for the dog:

Shade: ____ Doghouse: ____ Covered Area(porch, etc.): ____

Trees: ____ Other(explain): ____________________________________________

Describe your yard: Fenced: ____ Kennel Run: ____ No Fence: _____
Other: (describe)__________________________

If fenced or kennel run, describe material used: _____________________________

If fenced, what is the height and approximate size of fenced in area:

___________________________________________________________________

If fenced, number of gates? ___________________________________________

Are gates securely latched and/or locked? ________________________________

Where would the dog be kept when you are at work? ________________________
___________________________________________________________________

Where would the dog be kept when you are on vacation? _____________________
___________________________________________________________________

Where will the dog sleep at night? ________________________________________

___________________________________________________________________

How many hours would the dog be left alone each day? ______________________
___________________________________________________________________

Describe your homes level of activity level:

Busy (active/noisy): ________
Moderate (comings/goings): ________
Quiet (occasional guests): ________

Individuals who adopt a dog from TLC Chow Rescue are contacted periodically for an
update to help ensure that the animal successfully adjusts to its new life.
If you adopt a Chow from TLC Chow Rescue, do you give your consent to home
visits before and/or after the adoption?
__________________________________________________________________

What is the best time to call you at your home to check on how the adopted dog is
adjusting? _________________________________________________________

Behavior and Training

Would you be willing to participate in a formal obedience training program with your
Chow? _____________________________________________________________

Are you familiar with crate training? _____________________________________

Are you willing to provide training to resolve behavior problems? _______________

What kind of behavior do you expect from this dog? _________________________

___________________________________________________________________

Under what possible circumstance would you return an animal?

Housebreaking________ Chewing________ jumping up________
shedding________ Shyness/other fears________ digging________
barking________ Scratching or climbing on furniture________
other (explain)___________________________________________________________
Or None, __________________________________________________________

How and when would you discipline your dog if he made a mistake? ________________
_______________________________________________________________________
_______________________________________________________________________
__

Placement Information

Thank you for taking the time to complete is application. We appreciate people who
are willing to consider adopting a Chow.

If you have any comments or concerns about adopting a Chow or about our rescue
program, please feel free to share them with us.

You will be asked to sign an Adoption Contract which requires, among other things,
that the dog be returned to the rescue immediately should you no longer be able to
keep it. It may not be sold, transferred, or given to any individual or establishment.
You will also be required to take the dog to a veterinarian within 3 days of the date
of Adoption Contract for a check up and any necessary medical treatment.

The rescue makes no representation as to the physical condition, temperament,

habits, personality features, or other aspects of the dogs available for adoption. The
rescue is in no way liable or responsible for any damage, accident, or injury resulting
from the adoption of any dog or the future conduct of that dog.

All of the information I have provided in the application is true and complete to the
best of my knowledge. I understand that any deliberately false, misleading, or
omitted information that may affect a placement decision is grounds for removal of a
dog from my possession. Should a Chow be placed with me, it will reside in my
home as a pet. I agree to provide the dog the adequate food, water, shelter,
affection, and medical care, and to fulfill the conditions of the Adoption Contract.

By signing below, I acknowledge that I have completely read this application,

comprehend it fully, and understand that applying does not ensure approval.

Printed Name of Adopter: ______________________ Date: ________

Signature of Applicant: ________________________ Date: ________
Printed Name of Adopter: l______________________ Date: ________
Signature of Applicant: ________________________ Date: ________