Luv A Chin Rescue Adoption Application
First Name: *
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Last Name: *
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Street Address: *
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City, State & Zip Code: *
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Phone Number: *
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Alternate Phone Number:
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Email Address: *
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Please name the dog you'd like to apply for: *
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Are you applying for another dog within Luv A Chin Rescue?
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If yes, which one(s)?
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Why are you interested in adopting at this time?
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Are you applying for another dog from another rescue or shelter?
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If yes, which rescue/shelter?
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Have you adopted from Luv A Chin Rescue in the past?
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If yes, what dog did you adopt?
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Do you know any current or former member of Luv A Chin Rescue?
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If yes, who? What is your relationship?
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Age of Applicant:
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Occupation of Applicant:
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Occupation(s) of additional adults in your home:
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Please list household Members (Name/Age/Relationship to you):
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Does anyone in the household have allergies to dogs? If yes, how will that be addressed?
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Please list household pets (Name/Age/Breed/Gender/Altered (Spay or Neutered?):
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What pets have you owned previously? What breed(s)? When?
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How long have you been involved with Japanese Chin?
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Have you ever returned, rehomed, surrendered, or given up a dog?
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If yes, please explain circumstances of rehoming, surrendering, or giving up a previous pet(s):
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Who will be responsible for the care of the dog?
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Are you familiar with the potential health issues of Japanese Chin?
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If yes, please explain:
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Do you agree to have a representative of Luv A Chin Rescue visit your home by appointment?
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What type of home do you live in? For example, House, apartment, trailer, condo, other:
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If other type of home, please describe:
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Do you own or rent your home?
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If you currently rent, are you able to provide HOA/lease documentation stating that you are allowed to have pets?
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Are you a member of any other rescue organization/dog club?
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If yes, please list name of organization(s) and what you do for them:
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How many hours each day will the dog be alone?
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Where will the dog be housed when you are not home?
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If you are gone all day (more than 6 hours) what are your plans for a mid-day break for the dog?
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If you travel, where will the dog stay while you are traveling?
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Where will the dog sleep at night?
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Do you have a fenced yard?
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If yes, please describe your fencing:
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Does your fencing completely enclose a yard for a dog?
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If you don’t have a fenced yard, please explain how you will exercise the dog:
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Where will your dog spend the majority of it’s time? For example, house, yard, basement, garage, other:
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If other location, please describe where that will be:
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Are you willing to adopt a chin that is not house trained?
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If needed, are you willing to use potty pads in your home?
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Please tell us why you feel you would be the best home for this dog:
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If this is a special needs dog, please specify how you will address any specific needs of the dog:
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I am able to and willing to pay the adoption fee for this dog?
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Is there any other information that you feel would help us more fairly evaluate your application?
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REFERENCE 1 - First and Last Name
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Address (City, State, Zip Code):
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Phone Number:
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Email Address:
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How do you know this person?
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REFERENCE 2 - First and Last Name:
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Address (City, State, Zip Code):
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Phone Number:
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Email Address:
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How do you know this person?
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LANDLORD CONTACT INFORMATION, if applicable - First and Last Name:
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Address (City, State, Zip Code):
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Phone Number:
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Email Address:
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How do you know this person?
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VETERINARIAN INFORMATION - Vet’s First and Last Name:
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Vet Clinic Name:
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Vet Clinic Address (City, State, Zip Code):
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Vet Clinic Phone Number:
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Vet Email Address (if known):
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Please type your name here: *
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