YTNR Adoption Application Please fill out the form completely. Incomplete forms will be deleted. 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 Press the 'send' button when you are done. For correction before sending, press 'oops' If the form isn't working, please just E-mail Us your information. Finally, please note that donations on our placement dogs depend on the dogs age, health, and the value of medical costs put into the dog. We will ask you to make a 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. ALL QUESTIONS MUST BE ANSWERED. PLEASE DO NOT SKIP THEM!!!! E-mail is Required. If your application is incomplete, it WILL be deleted. 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) 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. Did you read the Bio on the dog(s) you are interested in, and do you feel your home is a good fit for this rescue? If yes, please explain: 10. Regardless of dogs location, do you agree to travel to meet and/or pick-up the rescue? 11. We do not ship our dogs, how many miles are you willing to travel? 12. Do you have Children? If so, please list their gender and age: 13. What experience do the kids have caring for dogs: 14. Does anyone in the family have an allergy to animals: 15. Ever had a Yorkie? If so, what happened to it? 16. Please list current pets, their ages and time with the family: 17. If dogs, list their breed(s), age(s) and sex: 18. Is your dog(s) fixed and if not, why? 19. Do you have a local Vet, and may we contact them for a reference? 20. If yes, please provide the following information: 20a. Vet Name: 20b. Address: 20c. City, State, & Zip: 20d. Phone: 20e. Fax: 20f. E-mail: 21. Do you have a local Groomer and may we contact them for a reference? 22. If yes, please provide the following information: 22a. Groomer Name: 22b. Address: 22c. City, State, & Zip: 22d. Phone: 22e. Fax: 22f. E-mail: Please list 2 personal references, preferably living on your street: 23. Reference 1 23a. Name: 23b. Address: 23c. City, State, & Zip: 23d. Phone: 23e. E-mail: 24. Reference 2 24a. Name: 24b. Address: 24c. City, State, & Zip: 24d. Phone: 24e. E-mail: 25. Will you allow a Rescue Volunteer visit your home: 26. Will you be able to take your Yorkshire Terrier through a basic obedience course: (If renting, we will require a letter from landlord, stating that this yorkie is allowed) 27. Do you live in a house or apartment, condo, or mobile home: 28. Do you have an enclosed backyard or patio? Please state which: 29. If yes, please describe height and approximate size: 30. Do you have a swimming pool: 31. If yes, do animals have free access to the pool? 32. If yes, for animals safety, will you be willing to install fencing to keep the rescue out of the pool area? 33. How many hours a day will this rescue be left alone: 34. Please explain where you will keep this rescue when you are not home: 35. If you go out of town for several days, who will keep the dog for you: 36. How do you feel about keeping your Yorkie outside or in a garage? 37. Please explain what kind of confinement area you have for your Yorkie Rescue, including size: 38. Do you agree to provide all necessary veterinary care for the dog, including annual booster vaccines, heartworm testing, heartworm preventative and general health care: 39. Why do you want to adopt a Yorkie: 40. Have you ever adopted a "rescue" dog? If so, from whom? 41. Do you have any experience with a dog that has been abused or neglected? If so, please explain your experience: 42. Some dogs bite out of fear. Are you willing to work with a dog that might be a fear biter? 43. If yes, please explain how you would handle it: 44. What age, size and gender Yorkie do you prerer? 45. Have you ever had a puppy? 46. If you want a puppy, please explain why: 47. Explain your opinion of putting a young dog with an older family/home: 48. Nobody wants to go through losing their pet, but have you considered what your pet will go through when he/she losses his/her home? In your opinion, is that better? Please explain: 49. Why would you prefer a young dog to an older one? 50. Why would you prefer an older dog to a younger one? 51. To ensure proper placement into the right home, what is the age range of the main caregiver of the dog? 52. Explain how you can provide a stable home for this dog? 53. If dog is adopted for a minor child of the family, what will happen to the dog when this minor child moves from the home? If he/she goes away to college? Are you, the parents, willing to keep the dog and care for it, love it and get it appropriate medical care for the rest of the dogs life? If so, please explain in detail: 54. Will you be able to financially provide for this rescue dog for the next 10+ years? 55. If you can no longer care for this rescue dog, do you have someone reliable who can minimize further disruption in this dogs life? Please give name and phone number: 56. To avoid future problems, are you willing to have only one person's name on the adoption contract? 57. Please explain how you will potty train your new rescue to go outside or use potty pads? 58. Are you aware that Yorkies are prone to bad teeth and require yearly dentals? 59. Are you aware that dentals can cost upwards of $150? 60. Are you committed to pay this cost for the rescue's dental? 61. Please tell us something about yourself and why you should be chosen for one of our rescue dogs: Press send only once! Return to Index ©2008 / YTNR Please do not remove anything from this page without permission from YTNR.