Chihuahua Rescue & Transport Adoption Database: Add a New Record

Add a New Record

ID:
Date:
First Name:
Last Name:
Email Address:
Address:
Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Best Time to Call:
Are you over the age of 21, living independently, and self-supporting? Yes No
If you checked "No" for the previous question, please explain:
What is your current profession?
How long have you been employed at your current place of employment?
Why do you want to adopt a Chihuahua?
What are the most important responsibilities of owning a dog?
Does every member of your household want a dog? Yes No
Does anyone in the household have allergies? Yes No
Have you had pets before? Yes No
Describe your previous pets (type, age, sex, spayed/neutered?):
Why are these pets no longer with you?
Describe your current pets (type, age, sex, etc):
Are all current pets spayed or neutered? Yes No
Are all current pets up-to-date on vaccinations? Yes No
Are all current dogs on monthly heartworm preventative? Yes No
Please provide the name, address, & phone number of your previous & current pets' veterinarian(s).

What name are these records listed under?
** Please contact your vet and give permission for them to release your vet records to CRT **
Are there other pets in the home that do not belong to you? Yes No
If you checked "Yes" to the previous question, please provide the name, address, and phone number of those pets' veterinarian(s).

What name are these records listed under?
Do you have children under the age of 18? If so, what are their ages?
Please list other residents in your household and their relationship to you:
How long have you lived at your current address?
In which type of home do you live? Single Family Dwelling Condo Apartment Mobile Home
Other
If you checked "Other" to the previous question, please explain:
Do you own or rent? Own Rent Other
If you checked "Other" to the previous question, please explain:
If you rent, please provide the name, address, and phone number of your landlord:
Do you have a fenced yard? Yes No
If yes, please describe your fence (size, type, etc.):
If you don't have a fence, how do you plan to keep your pet at home?
Where will the dog stay during the day? Indoors Crate Basement Outdoors Loose
Outdoors Fenced Yard Tied Up Outdoors Kennel Run Other
How much time will the pet spend outside?
Where will the pet sleep?
How frequently will the adults be gone away from home on business or vacations? Where will pet stay at these times?
Please describe your feeding plan - type of food, schedule, etc.:
Describe your housetraining routine:
Will someone be home during the day? Yes No
If you checked "No" to the previous question, how long will the pet be left unattended?
What provisions can be made if the pet needs to use the bathroom while left alone?
Please check any age preferences you have in adopting a dog: Up to 5 years 5 years or older No Preference
Please list any size preferences you have in adopting a dog: Up to 6 lbs. Up to 10 lbs. 10 lbs. or over No Preference
Are you willing to accept a dog with special needs? Yes No No Preference
Please list any gender preferences you have in adopting a dog: Male Female No Preference
Please list any other specific information that may help CRT find a Chihuahua for you:
If you are interested in any particular dog(s) on our website, which one(s)?
Please provide the name, address and phone number of at least two personal non-family references:
I understand that CRT will schedule a home visit with my family prior to final approval of adoption. Yes No

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