SEPRA Adoption Application

Note: All fields marked with an * are required.
If you do not fill in a required field, you will be given an error message prompting you to complete the required fields.

Personal Information

*First Name required field
*Last Name required field
*Address required field
*City required field*State required field *Zip Code required field
*Daytime Phone required field *Evening Phone required field
*Email Address required field
*Number of male adults in household required field*Ages of adult males in household required field
*Number of female adults in household required field*Ages of adult females in household required field
*Number of male children in household required field*Ages of male children in household required field
*Number of female children in household required field*Ages of female children in household required field
*Are you expecting a child or planning a family in the near future required field
*Are all family members in favor of adopting a rescue pug required field
If not, please explain
*Type of dwelling required field
If you selected Other, please explain
*Do you own or rent required field
If you rent, do you have the landlord's permission to keep a dog
Please provide landlord/apartment contact information for verification
*How long have you lived at your current address required field
*Are you planning on moving in the near future required field
*How many consecutive hours a day are you away from home for work, school, etc. required field
*Will you be hiring a pet sitter if gone a long time, or are you close enough to go home during the day required field

Type of Rescue

If interested in a pug on our website, please specify his or her name
*Color preference required field
*Age preference required field
*Sex preference required field
*Would you consider a pug mix required field
*Would you consider a special needs pug required field
*Would you be willing to adopt two required field
*Are you agreeable to returning the dog, should unforseen circumstances arise and you would no longer be able to keep the dog required field
*Would you be willing to allow us to visit your home required field
*Have you applied with any other rescue group required field
If you have applied with another rescue group, enter the name of the organization
*If out of state, are you willing to pick up the pug in person required field

Environmental Information

*What is the approximate size of your yard required field*Is your yard securely fenced required field
If you do have a fence, what type of fence is it and how tall is it
If you do not have a fence, will you get one if you get a dog
If your yard is not fenced, how do you plan to insure that the dog receives safe and adequate exercise
*Do you agree to keep a current ID tag on your adopted pug at all times required field
If no, please explain
*Do you have a pool required field
If you do have a pool, is it securely fenced
*Where will the dog sleep required field
*Do you plan to keep the dog primarily indoors our outdoors required field
*Please elaborate on how much time the dog will spend indoors and outdoors required field
*Do you plan to use a crate for housebreaking or while you are gone required field
*Why will you or why won't you be using a crate required field

Current Dogs
Breed
Name
Age
Spayed or Neutered
Gender
Stays Indoors/Outdoors


Breed
Name
Age
Spayed or Neutered
Gender
Stays Indoors/Outdoors


Breed
Name
Age
Spayed or Neutered
Gender
Stays Indoors/Outdoors


Breed
Name
Age
Spayed or Neutered
Gender
Stays Indoors/Outdoors

Current Cats
Breed
Name
Age
Spayed or Neutered
Gender
Stays Indoors/Outdoors


Breed
Name
Age
Spayed or Neutered
Gender
Stays Indoors/Outdoors


Breed
Name
Age
Spayed or Neutered
Gender
Stays Indoors/Outdoors

Previous Pets

Species/Breed How long owned
Stayed Indoors/Outdoors Spayed or Neutered
Where is pet now or what caused death

Species/Breed How long owned
Stayed Indoors/Outdoors Spayed or Neutered
Where is pet now or what caused death

Species/Breed How long owned
Stayed Indoors/Outdoors Spayed or Neutered
Where is pet now or what caused death

Please provide the same information about any additional pets you have/had

Pet History

Where did you get your current dog(s)
What activities do you participate in with your dog
Have you attended obedience classes with your dog
What type of heartworm preventative do you give your dog
What type of flea control do you use on your dog
What do you feed your dog (brand/type)
When nobody is home, where does your dog stay
Do you allow your current pets on your furniture
Would you allow a rescue pug on your furniture
Why are or aren't your pets spayed or neutered
Do you consider your current dog(s) aggressive or submissive to other people and animals

What circumstances, in your mind, justify giving a dog up? (Check all that apply)
Moving
New baby
Not getting along with other pets
Divorce
Getting out of fence
Behavioral problems
Children lost interest
If it gets too big
Too time consuming
Shedding
Allergies
Housebreaking problems
Medical problems
Aggressive behavior
Other reasons, please explain
*Have you ever given a dog up or had a dog for a brief period of time and it didn't work out required field
If yes, please explain
*If your pet develops a medical problem that becomes expensive, what would you do required field

Pug Knowledge

*What is your primary reason for adopting a pug required field
If gift or other, please explain
*Are you aware of pugs health problems required field
If yes, what health problems do you forsee
*Are you willing to take care of problems should they arise even if he/she requires daily medication required field
*Are you aware that pugs shed 365 days a year required field
*Are you aware the pugs snore, and if not are you willing to accept this required field
*Pugs are companion animals, they will want to be with you constantly. Are you prepared for this required field
* Do you realize that pugs can live upwards of 14 years and are you committed to care for it that long required field

Behavior

*What type of behavior(s) do you expect from this dog required field
*What amount of time and effort, per week, do you want to devote to training your dog required field
*Are you likely to enroll your dog in obedience class required field
*Which family members would be expected to assist in home training required field
*What is your definition of disciplining your dog required field
*What are your training objectives required field
*Who will be the primary caregiver for this dog (i.e. feeding, walking etc.) required field

References

List three references that can attest to your suitability as a pet owner, and more specifically, the owner of a rescued dog. If you own any pets now, please include your veterinarian as a reference. Please make your veterinarian aware that a SEPRA representative may be contacting them, and they need to be prepared to discuss you and your dogs interactions with them. With out the authorization from you, the vet will not release any information which will slow down the application and adoption process.

*Name required field
*Address required field
*City required field*State required field *Zip Code required field
*Phone required field
*How are they related to you required field

*Name required field
*Address required field
*City required field*State required field *Zip Code required field
*Phone required field
*How are they related to you required field

*Name required field
*Address required field
*City required field*State required field *Zip Code required field
*Phone required field
*How are they related to you required field

Conclusion

I, the undersigned, attest that, to the best of my knowledge, the above information is accurate and complete at the time of signing. I understand that falsely provided information can mean that my application will be terminated.

*How did you find out about us required field
Please let us know anything else that would make you an ideal candidate for a rescue pug
*Signature (please type full name) required field

website by plaine studios