Adoption Application

Thank you for your interest in adopting one of our kids! Please complete the following
adoption application.
Answer all questions to the best of your ability. All information will be kept confidential.
Approved applications will require a home visit by one of our volunteers. There is a $350.00
adoption fee for each dog adopted.
Mail your completed application to:
California Shar-Pei Rescue, P.O. Box 492404, Redding, CA 96049-2404
Please allow up to 10 business days for receipt and review of your application.
_________________________________________________________________________________

Family Information Part I

First Name: _____________________________

Last Name: ___________________________

Address: ________________________________________________________________________
City: ____________________________________ State: _______________

Zip: ___________

Home Phone: ____________________________ Cell/Work Phone: ________________________

Email: _________________________________
How long have you lived at the above address?
years ______________

months ______________

What type of home do you currently live in?

Single Family

Own

Duplex

Condo

Townhouse

Apartment

Mobile Home

Rent

www.CaliforniaSharpeiRescue.com

Page 1 of 7

If you rent, please provide us with your landlord's name and phone number.
Please note that we will contact your landlord to confirm that your lease permits
pets.

____________________________________________________________________________

If you have children living in your home, or that visit on a regular basis, please
indicate their name(s), sex, and age(s).

_____________________________________________________________________________
_____________________________________________________________________________
Do you have a fenced yard?

Yes

No

What kind of fencing do you have (e.g., chain link, privacy fence, invisible fence,
etc.)?
Type

_____________________________________________

Height in feet _______________

If you do NOT have a fence, how will your Shar-Pei be exercised and go to the
bathroom?
_________________________________________________________________________________
_________________________________________________________________________________

Where do you plan on keeping your Shar-Pei the MAJORITY of the time?
Inside
Other

Outside

Garage

Basement

Crate

____________________________________________________________

Where will your Shar-Pei sleep at night?

Inside
Other

Outside

Garage

Basement

Crate

____________________________________________________________

www.CaliforniaSharpeiRescue.com

Page 2 of 7

Where will your Shar-Pei stay when no one is at home?

Inside
Other

Outside

Garage

Basement

Crate

____________________________________________________________

All dogs adopted from us will be spayed or neutered. If you have any questions
or concerns about this policy, please explain:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

If your adoption application is approved, please indicate how you will arrange
for transportation of your Shar-Pei from Redding, CA:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Dog Preferences Part II

Which dog are you interested in adopting? ______________________________________

What are your preferences (e.g., age, sex, color, etc.) for your adopted dog?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Why do you want to adopt a Chinese Shar-Pei? Please give all reasons that apply
(companion, guard dog, gift, to breed, personal protection, for children, other).
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

www.CaliforniaSharpeiRescue.com

Page 3 of 7

Have you ever owned a Chinese Shar-Pei?

Yes

No

What do you know about Chinese Shar-Pei (temperament, health, etc)?

_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

If you have other animals, please indicate what kind (dog, cat, rabbit, etc.), breed,
age, and if the animal is spayed/neutered.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

If you have owned animals in the past, what happened to those animals? Please
provide details and reasons: (illness, accident, died, put to sleep, given away,
sold, lost, stolen, turned in to shelter, behavior problems)
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Are you familiar with heartworm preventative and the vaccinations that are
necessary?

Yes

No

Not Sure

Are your other animals, if applicable, current on their vaccinations and heartworm
preventative?

Yes

No

Not Sure

www.CaliforniaSharpeiRescue.com

Page 4 of 7

Please provide us with your veterinarian's name, address and phone number.
They will be contacted for a reference.

_____________________________________________________________________________

What will you do if your Shar-Pei exhibits bad behavior (e.g., being destructive,
soiling the house, barking, etc.)?

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Do you understand that your dog may not be housebroken and are you willing to
take the time to properly housetrain?

Yes

No

Not Sure

Do you understand that it may take your dog at least 30 days to adapt to his or her
new environment and family?

Yes

No

Not Sure

Would you be willing to adopt a dog with a medical condition, such as allergies,
thyroid problem, etc.? (Note: we will not adopt out a dog with a major medical
problem such as cancer.)

Yes

No

Not Sure

Would you be willing to adopt a dog with a behavior problem, such as chewing,
separation anxiety, fear of thunderstorms, not housebroken, etc.? (Note: We will
not adopt a dog that is aggressive or has bitten before--under ANY
circumstances.)

Yes

No

Not Sure

www.CaliforniaSharpeiRescue.com

Page 5 of 7

Please write any additional comments below. Use this space to also indicate any
health or behavior problems that you could NOT handle (dog aggression, cat
aggression, daily medication, etc.).

_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Terms and Conditions Part III

All applicants must read and agree to our Shar-Pei Adoption Terms and Conditions.
The following Shar-Pei Adoption Terms and Conditions are intended as a guideline for adoption. Our
primary goal is to find the best possible home for the dogs in our rescue. If this means bending the
rules then we may do so at our discretion. So, if you find that you do not fulfill all of the Shar-Pei
Adoption Terms and Conditions, but know that you could provide a great home for a Shar-Pei, please
do not hesitate to submit an application.
(1) People interested in adopting a Chinese Shar-Pei through California Shar-Pei Rescue must submit a
completed Adoption Application for approval. The application process helps us to match the correct
dog with the correct person. We have also found that people who are willing to fill out the application
are serious about providing a quality home.
(2) With a few exceptions, we will only adopt a Shar-Pei into an indoor home. We believe that Chinese
Shar-Pei are a very family-oriented breed and putting one outside is an invitation for disaster. Even
so, we do ask that adoptive homes have a fence, as fences provide a safe environment for your pet.
We do make exceptions to the fence rule but only to homes that can prove a successful history with
leash walking.
(3) All of the dogs that come into our rescue are screened for temperament and health before
placement. We will not knowingly place a dog with aggressive behavior problems. However, it is
possible that any dog may display unwanted behaviors or aggressive tendencies, depending on the
circumstances. In the case of serious behavior problems, we can provide advice and assistance to you
up to the point of accepting the dog as a return.
(4) Unless otherwise prevented by age or medical condition, all dogs will be spayed or neutered before
becoming available for adoption. Also, all dogs adopted from us are brought up-to-date on
vaccinations, as well as heartworm and flea preventative.
(5) California Shar-Pei Rescue will not adopt a Shar-Pei into a home where the other animals are not
spayed or neutered. Spaying and neutering your animals is one of the most important things that you
can do to help with the pet overpopulation problem. We do, however, recognize the fact that some
animals cannot be altered because of age or medical problems. Also, we recognize there are
responsible breeders who have intact animals. We are willing to consider adoptions into these types of
situations.
(6) California Shar-Pei Rescue requires a home visit by one of our volunteers for all potential adopters.
We will also check vet references to ensure that all current pets are up-to-date on vaccinations.
www.CaliforniaSharpeiRescue.com

Page 6 of 7

(7) Once your application is approved and your new Shar-Pei located, you will be asked to sign a
contract. Basically, the contract states that you agree to provide all necessary medical care for your
adopted Shar-Pei, and house the dog in the manner which was stated in your adoption application.
The contract also states that if, at any point, you are unable to keep your adopted Shar-Pei, it MUST
be returned to us. This means that the dog cannot be sold, given away, turned into animal control,
given to a friend or relative, or otherwise disposed of. This contract is in force for the lifetime of the
dog.
(8) Although, for logistical reasons, we prefer to adopt into homes within the state of California, we
will consider out-of-state placements. All out-of-state homes must have a home visit by one of our
volunteers, and provide transportation of your Shar-Pei from our location in Redding, CA to your
home. We do not ship our dogs.
(9) California Shar-Pei Rescue REQUIRES that dogs be returned to rescue if the owner finds out that
they can no longer keep the animal for any reason. This requirement is for the LIFETIME of the dog. If
the dog is being returned due to a correctable behavioral problem, we may offer to pay for a session
with a behaviorist to see if the problem can be overcome. It is our feeling that the dog should be given
every chance to succeed in its new home. Also, we like to believe that our adoptive owners are
committed to making their new relationship work. We want to provide our adoptive parents with any
support that we can.
(10) There is an adoption fee of $350.00 for each dog adopted. This fee helps defray part of our
rescue costs, including spaying and neutering, vaccinations, heartworm and flea preventative, and
medical bills. On average, we have spent $500 caring for each Shar-Pei that is adopted. We could not
operate without charging adoption fees.
(11) By submitting this application, you understand that Homeward Bound CSP, Inc., operating as
California Shar-Pei Rescue, and its officers, directors, volunteers, members, employees, agents, heirs,
successors and assigns (hereinafter HBCCSPR) cannot be held liable for any damage that an adopted
dog may cause. You are responsible for the daily care (feeding, exercising, etc.) of the dog for the
period in which he/she remains at your home. You agree that if at any time you are no longer able to
care for the dog, you will immediately notify HBCCSPR, so other arrangements can be made. You
understand that you may not place the dog into another home without permission in writing from
HBCCSPR.
(12) In consideration of HBCCSPR's acceptance of your adoption, you agree that you, your assignees,
heirs, distributees, guardians, and legal representatives forever release and shall not make a claim
against, sue, or attach the property of HBCCSPR for any actions, causes of actions, suits, liabilities,
claims, demands, damages or causes of any kind or nature whatsoever, whether presently existing or
arising in the future, whether known or unknown, which arise out of or are based upon any fact,
matter, claim or thing involving your adoption. You further agree to indemnify and defend HBCCSPR
against and save them harmless from any and all demands, claims, causes of action, or judgments,
and any and all expenses (including, without limitation, attorneys fees) incurred in investigating or
resisting the same, for injury to person, loss of life, or damage to property occurring during your
adoption, and until all applicable statutes of limitation expire, arising out of any act, omission, or
neglect of HBCCSPR.
_________________________________________________________________________________

By submitting this application, I declare that all of the information I have provided
is true and complete, and that I have read and agree to the Shar-Pei Adoption
Terms and Conditions.

__________________________________________
Applicant Signature

www.CaliforniaSharpeiRescue.com

________________________
Date

Page 7 of 7