Adoption Application Form

Your Name

Your Email

Your Address

City

State/Province

Zipcode

Home Phone

Work Phone

Cell Phone

What is your spouse/partner's name. If none, please write "n/a"*

Age *

Employer Name, Phone # and Years in Company*

How many adults are living in the household*

How many children are living in the household*

Do you wish to foster or adopt? Please give a brief reason.*

Why are you interested in adopting a dog at this time*

Have you ever had to surrender a pet? If yes, please explain*

We will attempt to provide you with an honest evaluation of the temperament on any dog we have to place. Do you realize that often times the complete history of the animal may not be known and you may encounter some behavioral problems*

Which animal are you interested in

How did you hear about us*

Have you ever owned a Yorkie or other SMALL BREED dog? Do you have any knowledge of the breed? Please explain*

Who in the household will care for the pet*

Do you travel often? Yes No

Where will the animal be kept when you are not home*

Where will the animal sleep*

Will the animal be kept inside or outside*

If the Yorkie you are applying to adopt is under the age of 18 months or is currently enrolled in a behavioral obedience class with the foster family, it is MANDATORY that the dog is signed up for professional obedience training with a certified trainer. Will you agree to do so and send us a copy of the certificate of course completion*

In what type of home do you live*

If you rent, have you received the approval of your landlord to have an animal. *

Have you applied to or plan to apply to any other rescue*

Veterinarian's Name and Phone Number. If more than one, please list all and the name the pet is listed under.*

Please list your current pets. Include Name, Breed, Sex, Age*

Is your pet up-to-date on all vaccines*

f your pet is deceased, please explain what happened to him/her*

Would you consider a dog with special needs*

Would you consider adopting more than one if they came together*

What will you do if the new pet doesn't get along with your current pet(s)?*

What traits are you looking for in a Yorkie Male Female Puppy Young Adult Companion Protective Companion for another pet

If you are a first time Yorkie owner, we recommend that you do research on the breed before applying for one of our dogs. Yorkies are a high maintenance breed that require a lot of attention. They are territorial in their homes, protective with their humans and tend to have behavioral issues as well as potty training issues. They have a lot of energy and tend to have high veterinary costs, especially as they age. Are you and your family prepared, both emotionally and financially, to provide a Yorkie with everything they require?*

If something happens to you, is there a family member who is willing to assume responsibility/provide a home for the dog*

If yes, please provide name and phone number*

List three references (not family members), phone number and email address:*

The total amount to be paid is $250, which includes the following:

$100 application fee: This fee is part of the total amount and must be submitted within 24 hours of your online submission. If payment is not received within that time frame, your application will not be processed further. By accepting the terms of this agreement, you understand that the $100 application fee is non-refundable. We make no exceptions. If you are approved to adopt from Emporium Yorkie Rescue, this $100 will be deducted from the adoption fee.

$150 processing fee: This fee covers administrative and processing costs associated with your application. This fee is also included in the total amount.

Therefore, the total amount of $250 must be paid at once. This amount is refundable under the conditions mentioned above.
Yes

Select a payment method which is most convinient for you*

I certify that the information entered on this applicant is true. Enter your name and date*

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