Application for Adoption

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Yankee Chihuahua Rescue and Adoption, Inc (YCRAA)

Application for Adoption

Only residents of Connecticut, Rhode Island, Maine, Massachusetts, New Hampshire, and Vermont can be considered for adoption of Yankee Chihuahua dogs.

Please complete this entire form.
Missing information and incomplete applications will not be considered.

If you can not complete the application or have questions, then please send email to

* First and Last Name

* Your Age:

You must be 25 years or older to adopt an animal. A valid ID is required.

* Street Address                                  Town/City                                    Zip

* State: CT / NH / MA / ME / RI / VT
Please note: We can not place dogs outside of these areas.
Contact Chihuahua Rescue and Transport (CRT) for info about adoption in your area.

Mailing Address (if different)

If you rent/lease, please bring your rent/lease agreement which states the type of pet you are interested in and that it is approved or permitted.

Otherwise provide the name and phone of your landlord so we can verify the pet is allowed. Be sure to inquire with your landlord about size, gender or other restrictions.

* Home Phone       Best time to call
   Cell Phone
   Work Phone

* Email Address (preferred contact method):

* Occupation

* Number of hours worked outside of home per week

* Who will be home during the day?

* Why do you want to adopt a Chihuahua?

* For whom are you adopting a Chihuahua?

* Does everyone in your household know that you are applying for a Chihuahua?
Yes, everyone in the household knows I am applying for a Yankee Chihuahua

* Does every member of your household want a dog?
Yes, everyone one the household wants a Yankee Chihuahua

* Does anyone in the household have allergies?

* Please describe those pets that are currently with you (type, age, sex, altered status)

* Have you ever owned a dog before? How many dogs have you owned in the past 10 years?

* Have you ever owned a Chihuahua before?

* What made you choose a Chihuahua - Chihuahua/mix?

* Please describe those pets that are no longer with you and why

* List all adults in household, including yourself, their ages and relationship to applicant.
(Please include all residents and housemates whether related or unrelated)

* List all Children in household and their ages; if none please state so.

* Who will be responsible for feeding, housebreaking / training?

* Do you own or rent your residence?

If you rent, please provide the name,
address and phone number of your landlord.

Please note: if you live in a condo, assisted care facility or senior housing,
we will need a letter from management stating you may adopt a dog from us.

* What type of home do you live in? (Condo, single family dwelling, apartment, etc.?)

* Where do you plan on having the dog sleep every night?

* How much time will you be able to spend outside with the dog?

* How many hours a day will the dog be left unattended? and where will they stay?

* How frequently will you be gone away from home on business/ vacation / trips?

* When you are on vacation where will the dog be kept?

* What do you intend to feed the dog?

* How will you house train the dog (please detail)?

We encourage all Foster Parents to Crate Train. It helps the foster adapt more quickly and with less stress when they find their forever homes.
* Are you familiar with Crate Training?

If applicable, enter the name(s) of any dog(s) on our web site that interest you.

List any preference you have in adopting a dog using the checkboxes below:
Note: If no selections are made then "No Preference" will be assumed.

Age
Up to 6 years
6 years or older

Sex
(Neutered) Male
(Spayed) Female

Size
Up to 6 lbs
6 to 10 lbs
Over 10 lbs

Please consider me for an adoption of a Special Needs Dog Yes No
Please consider me for an adoption of a Senior Dog Yes No

Are you willing to adopt an animal that has health problems? Yes No
If yes, then is there any specific health problem(s) that will not be accepted?

Please list any other specifics that would help us match a Chihuahua:

*Do you understand that YCR requires this dog to be spayed or neutered, and will not place dogs in households with intact dogs?
Yes, I under stand Yankee Chihuahua Rescue does not place unaltered Chihuahuas. Yes, I under stand Yankee Chihuahua Rescue does not place Chihuahuas in households with intact dogs.

Please note: if you are looking for an unaltered pet, YCRAA will not be able to place a Chihuahua with you. All adult Chihuahuas are altered prior to placement.

All Puppies are required to be spayed or neutered at the adopters expense and a YCR Spay /Neuter Contract and Paid in Full Receipt from their veterinarian.

* Will you keep the dog licensed, and have an ID (other than the license) on the dog at all times?
Yes, I under stand Yankee Chihuahua Rescue requires the dog be licensed and wear an ID at all times.

* Do you agree to contact YCR if you can no longer keep this dog?
Yes, I agree to contact YCR if I can no longer keep this dog.

* Will you allow a representative of YCR visit your home? YCRAA can not adopt to homes without a Home Visit.
Yes, I will allow a representative of YCR to visit my home.

The typical adoption fee is specified on the adoption page (includes microchip).

This donation helps defray the veterinary costs incurred for spay/neuter, immunizations, heart worm and fecal testing, microchip and other medical needs required by every Chihuahua placed by YCRAA, Inc.

* Please provide the name & address of the Veterinarian you will be using for this dog.

* Veterinarian Phone Number

Please remember to contact your Veterinarian to provide your stated approval for YCRAA to contact for reference.

Personal Reference: If you have a dog that attends Doggie Day Care or a Dog Walker please provide their information. (Not required, but recommended.)

Reference / Business Name

Street Address, City/Town, State, Zip

Phone

I represent that the information that I have provided on this form is the truth to the best of my knowledge and belief and hereby give my permission for you to use any of the above information to confirm that all information provided is the truth. This means you give us your permission to call references and that you allow us to contact your vet and that you hereby give consent for your vet to release the information in your current/past pet's health files to us.

* Signature
This is an Electronic Signature
It represents your acknowledgement everything you've entered is true.

Where did you hear about us? Comments?

Incomplete applications will not be considered.

Incomplete application require time to follow up and all info is important.
When you have answered all the questions:

Submit Application form: Reset Application form: