Please Note: We only adopt to Arizona Residents
Please fill out the application below if you are interested in meeting one of our dogs.

This form is used to help us understand your needs & your expectations. This information will help us in selecting the dogs we believe will be a good match for you and your family. Adopting a dog is a big decision and a lifetime commitment, so please help us in making a successful adoption!

Name of the dog(s) you are interested in

Names of any other dogs your are interested in

Name

Email Address

Address

City

State

Zip

Cross Streets

Home Phone

Cell Phone

Alternate Phone

How long have you lived in AZ?

What type of work do you do?

How long have you been with your current employer?

What age dog are you looking for?

Gender?

Coat length?

Color of dog?

Activity Level

Characteristics
CompanionProtectiveObedientServiceOther

If Other, please specify:

We want our new dog to do the following with us (check all that apply):
HikeJogBicycleTravelCampSwimBoatingRelax in the eveningPlay with the childrenplay catch
If Other, please specify:

Do you want your new dog to be?
OutdoorIndoorMostly IndoorMostly Outdoor

Have you adopted a dog(s) from Arizona Chihuahua Rescue before?
YesNo
If yes, list name of dog(s):

Have you had animals before?
If yes, what kind?
DogCatOther
What happened to them?

How many animals do you currently have?

Please list your current animals below:

Animal #1:
Kind
Breed
Age
Gender
Spayed/Neutered?
Vaccinated?
Next vaccines due date:

Animal #2
Kind
Breed
Age
Gender
Spayed/Neutered?
Vaccinated?
Next vaccines due date:

For additional animals please add the requested information below:

Current Veterinarian:
Veterinarian Phone Number:

About your home and family:
We Rent:
HouseApartmentOther
If you rent does your landlord allow dogs?
*We will need a copy of your lease agreement (that portion pertaining to the permission of the landlord for you to have a dog or dogs

We Own:
HouseCondoOther

Does your residence have a dog door?
yesno

If not will you be installing one?
yesno

Is your yard fenced?
yesno

If so, what type of fence?
BlockWoodChain LinkOther
If Other, please specify:
How tall is your fence?

Does your home have a pool?
yesno

If yes, is there a fence enclosing your pool?
yesno

How many children live in your home?

List their ages

How many adults live in your home?

Is anyone in your home allergic to dogs?
yesno

How often do children visit your home?

Will the new dog you wish to adopt be a gift?
yesno

How many hours per day would your new dog be unattended while your family is at work or school?

Where will your new dog be kept during the day while you are away?
InsideOutsideOther
If Other, please specify:
Where will your new dog be kept during the night?
InsideOutsideOther
If Other, please specify:

Our family's activity level is:
Very active and always on the goModerately active, at home a few nights per weekNot very active, at home 5-7 nights per weekSomeone is always home

When you are out of town do you plan to:

Take your dog with youLeave your dog with family/friendsLeave your dog home aloneHire a pet sitter for your dogBoard your dog

If you would have to move would you:
Take your dog with youFind another home for your dogReturn your dog

Are you familiar with crate training?
yesno

Will your crate train?
yesno

Would you be willing to take your dog to obedience training?
yesno

How much are you willing to spend on medical expenses per year for your dog?
$0-$100$100-$200$200-$500$500-$800No Limit

Would you consider adopting a dog with special needs?
yesno

How did you learn about us?
NewspaperFriend/RelativeVeterinarianEvenTVRadioAdopted from us beforeWebsite

If Website, which one?

Is there anything else you'd like us to know?

I acknowledge that all the information contained in this form is true and correct to the best of my knowledge. I understand that any misrepresentations of fact may result in the removal of the adopted dog from my home by Arizona Chihuahua Rescue

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