BCCR Adoption Application

BC Chihuahua Rescue (BCCR)
Online Adoption Application

This application form must be completed in its entirety. Incomplete applications can not be processed. Thank you for your understanding. Please write us if you have any questions.

Thank you for your consideration and for offering a loving home to a BCCR dog. We couldn't do what we do, without you.

*required fields (please note any required fields marked with a "*" must be completed before this application will submit).

Today's Date:
MM/DD/YYYY
Dog’s name you are applying for, if applicable:

Please provide the following contact information:

* First Name
* Last Name
Middle Initial
Title	(if applicable)
Organization	(if applicable)
* Street Address
Address (cont.)
* City
* State/Province
Zip/Postal Code
* Country
* Home Phone
Work Phone	(optional)
FAX	(if applicable)
* E-mail

Your Age (Note: If under 18 you must have a guardian's consent):
* Age
* Names and Ages of Any Other People Living in Your Home or Sharing Your Fenced Yard, please be specific or mark N/A if not applicable.

Name of Veterinarian (must be provided, if you have pets):

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
E-mail
URL

* Personal Reference 1:
Name
Relationship
Home Phone
E-mail
* Personal Reference 2:
Name
Relationship
Home Phone
E-mail
Preferred Age of Chihuahua:
Any age
Up to 5 Years
5 Years & Older
Preferred Size:
Any size
Up to 6 lbs
6-10 lbs
Over 10 lbs
Preferred Gender:
No preference
Male
Female
Other Preferences (Let us know more of what you are looking for in a dog and why you are choosing to adopt a Chihuahua):
* Will the dog be left alone during the day? If yes, how long?
* Where and how will the dog be kept while you are away?
* Are you prepared to housebreak the dog if necessary?
* Do you have a yard that is fenced securely enough to contain a Chihuahua? Please describe.
If not, how do you plan to exercise your dog and allow them to eliminate outdoors?
* Do you have other pets? If so, what type, names, ages & sex?
* If you have other pets, are they neutered/spayed?
Yes
No
N/A
Are they up to date on vaccinations & heartworm tests and medications? (NOTE: applicant may be asked to show proof)
Yes
No
N/A
Have you had any previous pets? If so, what happened to them?
Do you have any children? If so, what are their ages? How do they relate to dogs?
What type of dwelling do you live in and do you rent or own (i.e. a condo, apt, house, etc.)? Do you share your dwelling with other tenants and/or do you share the use of the yard or other outdoor space? Please give us additional information.
* If you rent, does your landlord allow you to have pets ? Please note - a letter of consent from your landlord is required.
Yes
No
N/A
* Will you consider any Chihuahua (different from age, size or gender preference indicated above) that comes into rescue? Select any of the following options that apply:
Yes
No
Maybe
N/A
* Are you willing to take the dog for an overnight visit before final consideration of your adoption can be determined and you may be asked to sign a waiver form as you will be assuming full responsibility to keep the dog safe from harm at all times and to do so at your own risk? Please feel free to also add any other details you think we should consider on this application.

IMPORTANT INFORMATION - PLEASE READ:

Adoption donations are usually between $75.00 - $400.00. The BCCR will insure that all dogs are spayed/neutered and up-to-date on vaccinations. Many times, our expenses can exceed the adoption donations, therefore we would appreciate any additional donation that you can make (any donation beyond the adoption fee, will receive a receipt for tax purposes).

TERMS AND CONDITIONS

I, the undersigned, hereby certify that I am of legal age (older than 18) and that all statements made herein make full disclosure and are true. Should there be any change in the circumstances as stated above, I undertake to notify BCCR as soon as possible.

I also understand that there may be multiple applications for a dog and that the BCCR will place each dog with the most appropriate home. My application will remain on file for one year. A homecheck is required before placement.

I verify my understanding and acceptance of the above terms and conditions.

Yes
No

Please enter the number that appears on the left.

(By submitting this form, you agree to all the above terms and conditions) - Please note any required fields marked with a "*" must be completed before this application will submit.

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