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Thank you for wanting to adopt a bichon! Please fill out
this form so that we may make the best match.
Information about You
Your Name:
Street Address:
City:
(Please note: Long Distance Calls will be returned
Collect)
Email Address:
Occupation:
Employer:
Other Adult Household Members:
Anyone over 18, and their relation to you...grown
children, spouses, significant others,
partners, relatives or
roommates...anyone the dog would encounter on a daily basis.
Children in Household:
Anyone under 18 who would be living with the dog.
Names, or genders if you prefer, and Ages...include any
children "on the way."
Other Dogs in Household:
Breeds, Ages, Spayed/Neutered?
Cats in Household:
Breeds, Ages, Spayed/Neutered?
Other Animals in Household:
Birds, Rabbits, Reptiles, Small Furries, Horses, Cattle,
Other Livestock
Veterinarian Information:
Name:
Clinic/Hospital Name:
Email:
Address:
City:
About Your Home:
Do you Own or Rent?
Own
Rent*
*Must submit Owner/Mgt. documentation
allowing Dogs.
How would you describe your dwelling?
Apartment, condo, townhouse, detached single family home, etc?
How long have you lived there? Do you have plans to move soon?
Would you call your neighborhood
Urban, Suburban or Rural?
Is there a fenced yard? How high is the fence and what is
it made of? If there is no yard, or no fence, is there a dog park nearby?
On Weekdays:
What times/hours is an Adult at home?
On Weekends:
What times/hours is an Adult at home?
Is this your First Dog?
If no, how long ago did you have your last
dog, what breed, what
happened to that dog, Vet's name and phone number if
different
from Vet listed above:
Have you ever had to Euthanize a pet?
If Yes, please explain the circumstances:
Where will the Bichon stay during the Day?
(e.g., in the house, in the yard, in a crate,
if a dog walker comes by during the day and what time, and so forth)
Where will the Bichon stay at Night?
(e.g., in the house, the yard, in a crate, in
someone's bed, etc)
If you were no longer able to care for a Dog, who would
take over care for you?
What sort of temperament are you looking for in a Dog?
What type of Interactions do you want to provide to a
Dog?
(e.g., close, constant, very frequent, occasional,
intermittent,
"at certain times" and so forth...)
What books or resources have you read/used to learn about
the Bichon breed?
What qualities appeal to you about the Bichon?
In addition to the "pros," what do you think the "cons"
are to owning a Bichon?
What other breeds have you investigated?
Estimate your monthly Grooming expenses:
Estimate your yearly Vet Care expenses:
What types of items do you expect to purchase to maintain
a Bichon:
What are your expectations/concerns about getting a
Rescued Bichon:
Would you consider a Dog that is not housebroken?
If you would, are you prepared/Do you know the effort
involved in Housebreaking a dog? If possible, describe your method:
What age dog would you prefer?
Would you consider a Dog that is over 8 years of age?
What sex dog would you prefer?
Would you consider a Dog of the opposite sex?
What weight dog would you prefer?
Would you consider a Dog that is between 19-25 pounds in
weight?
Would you consider a Dog that may have "special needs" -
mature, blind, deaf, missing limb, requires ongoing medical treatment, etc.?
What is the most you expect to donate to cover expenses
for a Rescued Bichon?
What is your time frame for obtaining a Dog?
Do you hereby certify that the information supplied by
you here is true and correct to the best of your belief and knowledge?
Yes, I do
hereby certify.
Do you hereby authorize any Veterinarian named above to
release any information and
records concerning your past or present care of animals to whomever may
present this
application in person, by mail, or by fax?
Yes, I
authorize this release of information, and agree to indemnify and hold
harmless any Veterinarian named here for providing this information
(Note: Even with the aforementioned authorization, you may also need to
obtain the Veterinarian records or call the Veterinarian to release the
information to a Rescue Volunteer if the Veterinarian does not release upon
presentation of this email/web information by the Rescue Volunteer.)
Please review all information for accuracy prior to
submission. Please give special attention to the accuracy of email addresses
and other contact information.
I
understand and agree that submission of an application does not in any way
guarantee that a Rescue can be placed with me.
For
the purpose of using this online application, I hereby agree to the use of
an identifier in lieu of my written signature. I understand that my written
signature may be required later in the application process.
As an Identifier, please state the city in which you were
born:
Any additional comments?
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