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In Memory of:
Mark Hogan
Mary Schmidt
Anne Henderson
Joe Doyle


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YTNR Adoption Application


Please fill out the form completely. Please fill in your e-mail address and personal information. This information is private and will not be given out to anyone other then rescue representatives in order to contact you when a dog becomes available. We have been receiving a large numbers of applications. Our volunteers are working on them and ask that you please be patient.. And thank you so much for taking the time to complete the application and for your interest in adopting a yorkie

Finally, please note that the amount of donations placed on our rescue dogs depend on the dog’s age, health and the value of medical put into the dog. We will ask you make a money order or cashier’s check out to Yorkshire Terrier National Rescue at the time of adoption and adoption fees are non-negotiable and non-refundable.

Each dog is Microchipped before going to it's new home. Read about our Microchip Policy here. Thanks.

Press the 'send' button when you are done. If the form isn't working, please
just E-mail Us your information. You can copy the form and paste it into your e-mail.




Please Click here BEFORE
Filling out Form


Please try to answer ALL QUESTIONS. Once you fill in all the required information, we will let you know that your form has been sent to a representative. (Please don't use a P.O. Box for addresses, we need an actual location)

(Please DO NOT hit the Enter button on your keyboard.
This will submit the form. You may use the tab button to go from question to question.)

1. Your Name:
2. Your address:

3a. Your City: 3b. Your State: 3c. Your Zip:

4. Home phone: 5. Work phone: 6. Cell phone:

7. E-mail:

8. If interested in a specific dog, please site their Name and State they reside in here. If there is more then one dog, please list them in order of your preference:

9. Ever had a Yorkie? If so, what happened to it?

10. Do you have a local Vet, and may we contact them for a reference?

11. If yes, please provide the following information:
11a. Vet Name:
11b. Address:
11c. City, State, & Zip:
11d. Phone: 11e. Fax:
11f. E-mail:

12. Do you have a local Groomer and may we contact them for a reference?

13. If yes, please provide the following information:
14a. Groomer Name:
14b. Address:
14c. City, State, & Zip:
14d. Phone: 14e. Fax:
14f. E-mail:

Please list 2 personal references, preferably living on your street:

15. Reference 1
15a. Name: 15b. Address:
15c. City, State, & Zip:
15d. Phone:
15e. E-mail:

16. Reference 2
16a. Name: 16b. Address:
16c. City, State, & Zip:
16d. Phone:
16e. E-mail:


17. Do you have an enclosed backyard or patio? Please state which:

18. How many hours a day will this rescue be left alone:

19. Please explain where you will keep this rescue when you are not home:

20. Please explain what kind of confinement area you have for your Yorkie Rescue, including size:

21. Please tell us something about yourself and why you should be chosen for one of our rescue dogs:



Press send only once!