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Do not enter anything in this text box otherwise your message will not be sent! Personal Information Name: * E-mail: * Age Spouse's Name Age: Best time to call: Morning Midday Evening Primary phone: Best time to call: Morning Midday Evening Cell Phone: Street Address: City: State: Zip: Adults (over 18) in household: Do you have children? Yes No If yes how many and ages: Do you own, or rent your home? Own Rent If you move, will you select a pet friendly housing? Yes Not Certain Do you smoke? Yes No Do you have a fenced yard? Yes, fully Yes, partly No If yes, select type of fence chainlink picket fence privacy fense other type Do you have a swimming pool? Yes No If you are interested in a specific dog, please list name(s) Do you use any professional lawn care? Your Preferences Briefly describe the dog you would like: gender, age, personality, etc. Are you open to a pair? Yes No Possibly Describe what is unacceptable in a dog. Are you familiar with the grooming and dietary needs of a Shih Tzu? Yes I need more information Are you familiar with the medical needs of a Shih Tzu? Yes I need more information Can you commit to keeping your dog groomed and fed a good quality food for its lifetime? Yes Not certain Can you commit to providing all necessary medical care for the dog for its lifetime? Yes Not certain How many hours will your dog be left alone on a typical day? 2 or less 4 or less 6 or less 8+ If your dog will be left alone more than 8 hours per day, describe your plan to check on the dog or accommodate the dog in your absence. Describe where the dog will stay when you are not at home. Describe your plans to provide care/shelter for your dog during vacations, hospitalization, death, or any other time you will be absent for an extended period. Please list any dogs you currently have - name, age, sex, breed, how long owned. Do you have any other pets? Please list. Please list previous dogs you've had and what happened to them. References Reference 1 - Veterinarian Clinic and Phone Number Reference 2 - Groomer Name and Phone Number Reference 3 - Landlord Name and Phone Number (if you rent) Personal Reference 1 - Name, State (country), and Phone Number How does this reference know you? Best time to call: Morning Midday Evening Personal Reference 2 - Name, State (country), and Phone Number How does this reference know you? Best time to call: Morning Midday Evening Please list any alternative references and phone numbers Please list any questions or concerns you have regarding this application or our adoption process.We also invite you to list additional information about yourself that might help us find you the right dog. All of the information I have provided is true and complete to the best of my knowledge. Applicant Name Date Thank you for your interest in adopting a rescue Shih Tzu from Shih Tzu Rescue of Wisconsin. The information on this form is for the evaluation and use of Shih Tzu Rescue and will not be shared with any third party.