Placement Questionnaire & Application

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This questionnaire is intended to be a guide to help you think about all the ways a Shih Tzu will impact your life and also determine if a Shih Tzu is the right breed for you. All of the questions concern various aspects of dog ownership that should be given serious consideration before deciding to share your life with any dog. It is by no means meant to be a test which will be used to disqualify you from consideration for a Shih Tzu. We are a Texas Nonprofit organization. We have received our non profit determination of exempt status from the Internal Revenue Service and are a 501(c)(3) non profit orgainzation.

Please note: We will only handle adoptions in the Dallas/Ft Worth area and we require an adoption fee of between $180 - $300. We are supported totally by donations and your adoption fee will be used to get a rescue the medical attention he/she needs.


Your Family

* - Required Fields
How did you hear about our organization?

If you have applied with any other groups we will try to co-ordinate our efforts with them.
Please list other groups you have applied with:

*Name: *Home Phone: Work or Cell Phone:

*E-mail: 
*Address:   
*City: 
* State: 
Zip:     
Country: 
Marital Status: Occupation : Yourself Spouse: Number in household? Ages of household members?
Children? If Yes, what age?
Why do you want a pet?

Preferences

Please remember that we may get several applications on each dog, so please indicate all dogs that you may be interested in and whether or not you would like to be pre-approved for a future adoption when a dog becomes available for you if the dog you are interested in is not currently available.
If you are interested in a particular dog, please tell us the dogs name:

If the dog you are specifically interested in is not available would you consider another Yes No

I would be interested in another (check all that apply): Male - Female - Older dog - Special needs -

Please note:The average age of a rescue is between 3 - 8 years of age. The average Shih Tzu can live to be 15 - 18 yrs old. If you prefer a younger Shih Tzu, your wait will be longer. We rarely have puppies. All rescues will be spayed/neutered before adoption.


Please specify any preferences below.

Sex:
Are you willing to accept a dog requiring daily eye or other medications?
Are you willing to accept a dog with a history of neglect/abuse who needs extra love and attention?
Are you willing to accept a dog who may require additional behavior or house training?
How willing are you to work with addition housetraining?
Any Additional Comments on above preferences:


Would you consider a Shih Tzu mix?
How long are you willing to wait for a Shih Tzu?


Why A Shih Tzu

Have you previously owned a Shih Tzu? 

What do you like about the breed?            

                

Please describe what you feel are the characteristics of the ideal Shih Tzu for you and your family.

Your Home

Which of the these best describes your current residence? 

Does your lease or home owners assoc. restrict pet ownership?

If you lease an apartment or home, have you checked on the required pet deposit? 

Are you willing to pay the required pet deposit for your leased home?  

Does your town or city have restrictions on the number of dogs you can have?

Is your yard, or a portion of your yard, securely fenced with no gaps through which a dog might escape?

Do you have a pool? 
If you have a pool, are you willing to purchase and use a recommended pool alarm? 
If you have a pool, is it fenced?

If you have a dog run, is it secure?
Do you have a doggie door? 

References

Please provide three names as references, including your veterinarian, groomer, and your landlord (if you rent your home). Other references could include a neighbor, your employer, a friend or relative who owns a Shih Tzu, other toy breed or other high maintenance breed (such as poodle or Afghan Hound).
Name, Phone number and relationship to applicant:


Care and Responsibility

The Shih Tzu is a high maintenance dog, and while you may love the breed you may discover that you do not have the time or the resources to devote to its upkeep. But if you do, the Shih Tzu will more than repay you with a lifetime of loyalty

Are you prepared to pay someone up to $40, or more, every 4 weeks to groom your Shih Tzu? Or are you prepared to purchase a grooming table, clippers, scissors and other accessories and devote the time to learn to groom your Shih Tzu yourself?

Are you willing to spend approximately one hour each week brushing and combing out your Shih Tzu? This additional maintenance is required whether the dog is being professionally groomed or you are grooming your dog yourself. Are you willing to pluck the hair from the inside of the ears monthly to prevent infections and to clean the eyes of accumulated matter daily if necessary? Are you prepared to deal with the cost of both routine veterinarian care (worming, annual shots) and non-routine/emergency veterinary care, especially as the dog gets older?


Approximately how many hours a day will your new Shih Tzu be alone?
Where will your Shih Tzu spend the day while you are away from the house?
Comments:
How much time during the day will you have to spend with your Shih Tzu?
Where will your Shih Tzu sleep at night?
Who will have primary responsibility for the care of your Shih Tzu?

How will you transport your pet when traveling by car?

For what reason(s), if any, would you feel compelled to give up an animal? House training problems
Animal Aggression People aggression Medical Expenses Not enough time to devote to a pet
Fence jumper/escape artist Destructive in home/yard Moving and unable to take pet


If you would not give up the pet, how would you handle a problem such as housetraining, aggression,
or destructive behavior?


Do you know what heartworm disease is? Yes No
If you own a dog, what is your current heartworm prevention program?  


Are you willing to get obedience training for your pet if recommended?  
Are you willing to buy and use a crate, or other types of confinement, if recommended?
Are you able to confine a dog to an area while you are gone? If so, where?

What food do/did you feed?

How often do/did you feed? Food left down at all times Once a day Twice a day

Are you aware that some Shih Tzu are prone to allergies?

Are you willing to accept a Shih Tzu with allergies or are you willing to medically handle any allergies that he/she may develop?



History of Pet Ownership

What animals currently live in the household? 
(Please list type of animal, sex, age, date of last vaccines,Neutered?, and how long you have owned them)


Are they kept inside or outside?


Please list any dog you have owned in the past and explain what happened to it.


Of the dogs that you own or have owned, what do you enjoy most about dog ownership?


What do you like least about dog ownership?


Do you understand that the adoption fee is between $200-$300 and that this money will be used to help us continue in 
our rescue efforts?

Will you authorize a visit to your home both before and after you adopt your pet? It will speed up the adoption process if you would have your vet fax your vet records to us at our toll free number
1-866-546-5719.
I will have my vet fax the records to you


All of the information I have provided is true and complete to the best of my knowledge. Should a Shih Tzu be placed with me it will reside in my home as a pet. I agree to provide the dog with adequate food, water, shelter, affection and medical care. Signature of Applicant: Date of Application:
Thank you for taking the time to complete this questionnaire. Your answers will permit us to more effectively match available dogs' needs with your lifestyle and requirements.

   

Please hit the send button only once.
You will be taken to a confirmation page when send process is completed.


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