Pug Rescue of Central New York

Adoption Application

Pug Rescue of Central New York (PRoCNY) is a volunteer organization established to provide for the rescue, care and placement of purebred and mixed-bred pugs who have been abandoned, surrendered to us by their owner, or relinquished to an animal shelter.  PRoCNY welcomes applicants interested in adopting these special dogs.  Please note we do not run adoptions on a "first come, first served" basis, but try to match the most appropiate home for each dog.  We cannot guarantee when and if a pug will become available for you.  A home visit, interview and reference check are required before application approval.  Thank you for your interest!

1.) Date: ___/ ___/ ___

2.) Name  :________________________________________________________________________

3)   Age of applicant: _________

4.) Street Address:  ________________________________________________________________

5.) City:________________________  State: ______________________  Zip:_________________

6.) Phone: ( ____)________________Email:_____________________________________________

7.) Do you live within our coverage area?  Yes   No 

8.) Occupation: ___________________________________________________________________

9.) Employer's Name:_______________________________________________________________

10.) Employer's Address:_____________________________________________________________

11.) Employer's phone number:________________________________________________________

12.)  List 2 references: Name, phone number and relationship to you:

1.____________________________________________________________________________

2.____________________________________________________________________________

13.) Do you presently own a dog?  Yes   No

If you own dog(s), please indicate breed, age and sex:

______________________________________________________________________________

If you own dogs, are they spayed or neutered?  Yes   No

If not, please explain why:

______________________________________________________________________________

14.)  Every dog adopted out by PRoCNY is spayed/neutered.  Is this acceptable to you?  Yes   No

15.)  What other pets/animals currently reside in your household?

______________________________________________________________________________

16.)  Have you owned dogs in the past?  Yes  No

If Yes,  please indicated breeds and what happened to them (died, gave away, ran away, etc.):

______________________________________________________________________________

17.)  Name and address of current or past veterinarian (within 3 years):

______________________________________________________________________________

18.)  What is your living situation"

Own:  House  Condo  Trailer  Other__________________________

Rent:  House  Condo   Trailer Other__________________________

***If you rent, please provide a letter from your landlord stating that you are allowed to keep a dog on the premises with your  application.

19.)  Do you have any people under the age of 18 living with you?   Yes   No

If yes,  how many and what ages?

______________________________________________________________

20.)  Do you have any people over the age of 18 living with you?   Yes   No

If yes, how many? ______________________________________________________________

21.)  Do you have a fenced-in backyard?  Yes   No

If not, how will you exercise the dog, confine the dog, and provide  for his/her need to eliminate?

______________________________________________________________________________

22.)  Do you have a pool?  Yes   No

If yes,  Is the pool fenced separately?  Yes   No

23.)  Approximately how many hours a day will the dog be alone? ____________________________

24.)  Where will you keep the dog during the day? _________________________________________

25.)  During the night? _______________________________________________________________

26.)  When no one is home? __________________________________________________________

27.)  During your absence overnight?____________________________________________________

28.)  Please describe how, when and why the dog will be restricted:

______________________________________________________________________________

29.)  What will you do if the dog is destructive when you are not at home?

______________________________________________________________________________

30.)  Are you willing to attending obedience classes?  Yes  No

31.)  Have you ever trained a dog before?  Yes   No

32.)  Are you prepared and willing to spend the next 10 years taking care or the dog?  Yes   No

33.) What will you do if you move? _____________________________________________________

34.)  Is anyone in your household allergic to dogs?  Yes   No

35.) What are the legal requirements for dog ownership in your community (# limit, license, leash law, etc)?

_______________________________________________________________________________

36.) In your opinion, what circumstances justify getting rid of a dog?

_______________________________________________________________________________

37.)  The following questions refer to any preference you may have regarding a potential rescue pug.

a.) Do you prefer:  male    female    either

b.) Do you have a color preference?   fawn     black    either

c.) Would you be willing to adopt a pug-mix?   Yes    No

d.) Do you have an age preference (please circle all that apply)?

no preference 

6 months or younger

6 months-3 years

3 years -7 years

7 years and older

other _________________________________________________________

E.)  Would you consider adopting a special needs pug?  Yes   No

If yes, please circle needs you would be willing to accept:

handicapped:   blind  / deaf   /  crippled

medical: chronic conditions /  treatable injuries or illness /  hospice

behavioral:  previously abused or neglected.

38.)  How have you educated yourself about this breed?

________________________________________________________________________________

39.)  Why do you want a pug?

________________________________________________________________________________

________________________________________________________________________________

40.)  How long are you willing to wait for a rescue pug? __________________________________

I certify that the above information is correct to the best of my knowledge. I understand that any pug I may adopt will be spayed and neutered before placement.  I  understand that Pug Rescue of Central New York has the right to refuse any application, and that even if my application is accepted, they cannot guarantee if and when a pug may become available for adoption that fits the preferences I have stated in this application.  I further understand that there is a mandatory adoption fee of $250-375 per dog, although special needs and senior dogs may be less.  Finally, I give permission to Pug Rescue of Central New York to check my references, verify my employment, and contact my veterinarian to confirm the vaccination status of  any animals currently in my household.

Signature:_____________________________________________________

Thank you for taking the time to fill out this application.  Please mail it to:

PRoCNY

c/o Ronnie Zappala

105 Center Street

Syracuse, NY 13209

315-487-2500