Rocky Mountain Yorkie Rescue

Adoption Application

Please fill out our online Adoption Application and click the SUBMIT button at the end. You must answer every question for the application to submit properly.

PLEASE READ THE FOLLOWING:

We do not adopt dogs in homes outside the State of Colorado.
We need a valid email address in order to process your application.
We do not usually adopt dogs to families with small children... sorry!

I agree to give Rocky Mountain Yorkie Rescue permission to use my information below throughout the process of considering acceptance of the dog described. *

My info can be kept as needed during process and on record as needed. I may request to be removed from consideration by notifying the RMYR..

Name *

Age *

Phone *

Email *

Street Address *

City, State and Zip code *

Occupation (If none, type in "none") *

Spouse info (Name, age, and occupation of spouse) *

(If no spouse, type in "none"):

Ages of anyone else residing in the home including ages of your children at home or visiting on a regular basis *

(If none, type in "none")

Are you interested in a specific Yorkie we have on our site? If so list the name of the dog: *

Have you ever owned a Yorkie? If yes, where is that Yorkie now? *

How many hours per day will the Yorkie be left alone? *

Will the Yorkie be crated? *

Yes
No
Not sure

If pet is not crated, where will it be kept when you are not home? *

Where will the dog sleep at night? *

Name and Phone number of the Veterinarian you use now or one you have had in the past with previous animals: *

How many dogs you currently own? *

Describe the dogs you currently own: *

Breed, Sex, Age, how long have you had them and are they spayed/neutured?

How many cats do you own? *

If yes, are your cats spayed/neutered?

Do you own any other type of animals, if so, what are they? *

(If no, type in "none")

If you own other cats and dogs, are they current with all of their vaccinations? *

What happened to the pets you have had in the past? *

If you ever had to give a pet away, please explain the circumstances: *

Do you have a fenced-in backyard? *

How long have you been at your current address? *

Do you live in a: *

Do you own or lease? *

If you have a landlord do you have his permission to have a dog? (If yes, you will have to provide a letter from your landlord) *

Any restrictions on pets in your community? *

Are you planning on moving in the near future? *

If you move, what would you do with your pet? *

Do you understand that often times the complete history of a rescue dog may not be known? *

What type of social or behavioral problems could you not handle? *

Who will be responsible for the medical care and training of this animal? *

If you are elderly, who would take your pet if something happened to you? *

Are you willing to work with housebreaking issues? *

What brand of Heartworm Preventative do you currently use? (If none, type in "none") *

What brand of Flea Control do you currently use? (If none, type in "none") *

There are times when unexpected and often very expensive medical conditions occur. What will you do if this happens to your pet? *

Type in any additional comments: *

Date this application was sent in: *

By checking this box, I hereby certify: that the information above is truthful and correct. *

I hereby certify: that the information above is truthful and correct.

Phone

IMPORTANT: Read before clicking onto the SUBMIT button.
Carefully review this application. Every question must be answered.
If you leave out an answer, you will be returned to this page.
If this form did not work for you, please email us.