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Application for Adoption Yankee Chihuahua Rescue and Adoption, Inc (YCRAA)

This form is the Adoption Application. Please complete all required entries marked with a red asterisk*.
This form will not be able to submit without all the required questions answered.  Please be as detailed as possible.

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

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

*

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


* 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?





* Yes, everyone in the household knows I am applying to adopt a Yankee Chihuahua

*
Yes, everyone one in the household wants to live with a Yankee Chihuahua

* Does anyone in the household have allergies? E.G. Animal dander, ...  List all.

* Describe any/all pets that are currently living with you (type/breed, age, sex, altered status, etc.)

* Have you ever owned a dog before?
                		If yes, then how many and what breeds in the past 10 years?

* Have you ever owned a Chihuahua before?        

* Why did you choose to adopt a Chihuahua [or Chihuahua/mix] rather than any other breed?

* Describe any/all previous pets that are no longer with you and why (deceased, kids took it, moved to pet-free home, ...)


* List all adults in household, including yourself, their ages and relationship to you.
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?


Please note:  If you live in an apartment, a condo, assisted care facility, senior housing, or any other type of rental/leased home that you do not own, then you must provide a letter (on letterhead paper) from management stating they approve that you may adopt a dog from us.

If you rent/lease, then you must bring your rental/lease agreement which states the type of pet you are interested in is approved or permitted in the home.  You must also provide the landlord's name and telephone for verification.
Be sure to inquire with the landlord about size, gender or other restrictions before submitting an application.
* What type of home do you live in?
                                                       , please specify:
* Do you own or rent your residence?
 If you rent, then enter the name, address and phone number of your landlord.

* Where

* 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, or 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


We crate train.  It helps the dog 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
Please consider me for an adoption of a Senior Dog            

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:


YCRAA will not be able to place a Chihuahua with you if you are looking to adopt an unaltered pet.
        All adult Chihuahuas are altered prior to placement
        All puppies are required to be spayed or neutered at the adopters expense
        A Spay/Neuter Contract and Paid In Full receipt from their veterinarian will be required

* Do you understand that YCR requires this dog to be spayed/neutered, and will not place it in households with intact dogs?


* Will you keep the dog licensed, and have an ID (other than the dog license) on the dog at all times?


* Do you agree to contact YCR if you can no longer keep this dog?


* Will you allow a representative of YCR to visit your home? YCRAA cannot adopt to homes without a Home Visit.

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

This adoption fee helps defray the veterinary costs incurred for spaying/neutering, immunizations, heartworm 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'll use 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

Reference phone number

IMPORTANT: By typing your full name in the signature field below, you acknowledge that your typed name holds the same legal standing as your handwritten signature. By e-signing this form, you confirm that the information provided is accurate to the best of your knowledge and belief. Furthermore, your e-signature authorizes us to verify this information, including contacting your references and veterinarian. You also consent to your veterinarian sharing information about the health records of your current or past pets with our organization.

* Signature:  

Where did you hear about us?  Comments?


Incomplete applications will not be considered.  Please provide much detail for consideration.

Incomplete applications require time to follow up and all requested information is important.
When you have answered all the required questions:

Submit Application:                     Reset form:    CAUTION This will clear the entire form.