 If you are
interested in potentially adopting a
Shih Tzu, Shih Tzu mix or other small breed dog in our program, please complete this application in its
entirety. Failure to provide answers to all questions will result in your application
automatically being denied. If a question does not apply to
you, please answer with "N/A". Your application will help us in
deciding the best placement for you and our dogs. Applicants must be 21
or older.
A note to senior applicants: We suggest our senior applicants
consider adopting an older
Shih Tzu. A healthy Shih Tzu can live 15+ years, and they often do not really begin to
show their age until they are 10-12 years of age. Please think about
how YOUR age and state of health will affect your new dog's future. Many
pets are abandoned because their caregiver has to leave them to enter a
nursing home, and family members do not always have the
space, desire or ability to care for a pet left displaced by such an
event.
Once your application has been received, you will be contacted
by CSTR within a few days to a week, depending on volunteer
availability.
Please Note: The reference verification process
typically begins within 24 hours of application submission. In order to
facilitate the process, we ask that you contact your three personal
references, your vet and groomer reference (if you have one) and let
them know to anticipate our call. If all parties listed on this form are
anticipating our call and respond accordingly, we can often get back to
you within 24 hours. If your vet or groomer needs your authorization to
speak to us or if one of your references does not recognize the number
on their caller ID, the process can take a significant amount of time.
Also, please remember to give us the name of any current pets you have
and the name they may be listed under at your vet or groomer's office,
if different from yours. If you had a different last name when you had
your pet, that can slow down the process, as well. The more information
you can provide us with, the quicker we can process your application.
Our organization is volunteer and foster based. There may
be times when a dog you have selected is not a good fit for your home or
has been adopted. Please do not be offended if we offer an alternate
suggestion. Because our foster parents know their dogs so well, we are
able to tell you if a certain dog may not be a good fit for your
particular situation, and we may be able to offer a dog that will work
out better in your home. Please feel free to ask us for suggestions and
give us as much information as possible to allow us to partner with you
in finding your forever friend.
We work very hard to find the best match possible for your home.
Please be patient with us. It takes our volunteers time to call your
references, and many times we play phone tag with them for several days.
You will be kept in the loop. Should we need additional information from
you, we will send you an e-mail. If you have questions about your
application, please feel free to e-mail us. If at any time during the
process you decide to adopt from a different organization or want to
withdraw your application, please e-mail us and let us know. Nothing
frustrates family and friends more than unwanted phone calls. It also
slows down other applications if you have changed your mind while we are
still calling on your application and another is waiting its turn.
If you have any questions or concerns, we would be happy to discuss them with you. Please contact us at cstr.board@crossroadsrescue.org.
Thank you for considering a rescued dog!
*Required Field
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| *Applicant Name: | |
| Email Address: | |
| *Street Address: | |
| *City: | |
| *State: | |
| *Zip: | |
| *Applicant Age (Must be 21 or older): | |
| *Primary Phone: |
|
| Alternate Phone: |
|
| Alternate Phone: |
|
| *Best time to call: | |
| If you do not have an email address, may we call you collect if we need to contact you?: | |
| *Adults (over 18) in Household: | |
| *Do you have children living with you?: | |
| *If YES, what are their ages?: | |
| *Are all of the adults in the household in agreement about adopting a new dog?: | |
| *Which of the following bests describes your current residence?: | |
| If you rent or lease, please provide the following information: |
| Landlord's Name: | |
| Address: | |
| Primary Phone: | |
| Alternate Phone: | |
| *If you move, will you select pet-friendly housing?: | |
| *Do you smoke?: | |
| *Do you have a fenced yard on your property?: | |
| Fence Type: | |
| Other Type: | |
| How high is the fence?: | |
| Is there a specific dog you are interested in?: | |
| If YES, what is the dog's name?: | |
| *What types of Shih Tzu are you most interested in adopting (female, male, age, color, size, etc.)?: | |
| *Would you be willing to adopt a Shih Tzu mix?: | |
| *Is this dog going to be a gift for someone?: | |
| *Would you consider adopting a pair?: | |
| *What situations would cause you to not be able to keep this dog?: | |
| *Do you understand that in the event you are no longer able to keep this dog, you are required to return him/her to Crossroads Shih Tzu Rescue Inc.?: | |
| *As with any rescue dog, Shih Tzu are often not housebroken, have been abused in the past, or may have treatable medical problems and in some cases, these types of problems may not be realized until after the dog has been places in its new home. If you are approved for adoption, are you willing to work with your new pet to give it the new life it deserves? | |
| *Are you familiar with the grooming and dietary needs of a Shih Tzu? | |
| *Are you familiar with the medical needs of a Shih Tzu? | |
| *Can you commit to keeping your dog groomed and fed a good quality food for its lifetime? | |
| *Can you commit to providing all necessary medical care for the dog for its lifetime? | |
| *Do all adults in the household work full time? | |
| *Approximately how many hours each day will your dog be left alone? | |
| *Your newly adopted pet's living situation (check all that apply) |
Indoors(except for potty)
Indoors and outdoors
Garage/basement
Outdoors only
Outdoors only with dog house/shade |
| *When home alone, where would your newly adopted pet stay? (check all that apply) |
Loose indoors
Confined to one room
Kept crated indoors
Kept crated outdoors
Outside loose in fenced area
Outside loose in unfenced area
Tied/Chained outdoors |
| *How will you exercise your dog? (check all that apply) |
Leash walks daily
In outdoor kennel/run
Free run of fenced yard
Free run of unfenced yard |
| *What other animals do you have? List each (include Breed, Age, Gender, Spayed/Neutered, Length of time with you): | |
| *If you have had pets in the past, what happened to them?: | |
| *Under what circumstances do you believe a pet should not be spayed or neutered?: | |
| *Are there any restrictions where you live on the number of dogs you may own?: | |
| If YES, how many are you allowed to have?: | |
| *Do you give
your current dog(s) heartworm preventative?: |
|
| *Does anyone in your home have allergies?: | |
| *What do you consider to be reasonable YEARLY ROUTINE veterinary expenses for your new pet? |
Under $50
Under $100
Under $200
Under $300
Under $400
$400+
I have no idea but would be willing to spend whatever is necessary to keep my new friend happy and healthy |
| *What will you do if your new pet becomes destructive?: | |
| *Under what circumstances would you consider finding somewhere else for your pet to live?: | |
| *What would you do if you could not keep the dog?: | |
| *What behaviors would you consider unacceptable?: | |
| *What would you do to correct the above behavior? (check all that apply) |
Go to dog training classes
Contact Crossroads Shih Tzu Rescue
Contact a private trainer
Give dog away to someone else
Other |
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References are very important to us! You MUST include references. All references must be over the age of 18 and only ONE of the personal references can be a relative. Failure to follow this policy will result in return of your application for additional information, and a delay in processing your application.
|
| *Do you have a veterinarian now, or one that you have used in the past?: | |
| Veterinarian's Name: | |
| Veterinarian's Phone: | |
| *Do you have a groomer now, or one that you have used in the past?: | |
| Groomer's Name: | |
| Groomer's Phone: | |
| *Personal Reference 1 Name (Only one reference may be a relative and all references must be over the age of 18.): | |
| *Phone Number: | |
| *Relationship: | |
| *Best time to call: | |
| *Personal Reference 2 Name (Only one reference may be a relative and all references must be over the age of 18.): | |
| *Phone Number: | |
| *Relationship: | |
| *Best time to call: | |
| *Personal Reference 3 Name (Only one reference may be a relative and all references must be over the age of 18.): | |
| *Phone Number: | |
| *Relationship: | |
| *Best time to call: | |
| *Please list any questions or concerns you have regarding this application or our adoption process. We also invite you to list additional information about yourself that might help you find the right dog: | |
| *I agree to return the adopted animal to Crossroads Shih Tzu Rescue if I can No longer care for it: | |
| *I am financially/physically able to care for the adopted animal. I understand the expenses involved in pet care and I am able and will meet these requirements: | |
| *I certify that my answers are true and complete to the best of my knowledge: | |
| *If this application leads to an adoption, I understand that false or misleading information in my application will result in CSTR reclaiming the adopted animal(s): | |
| *I understand that should I adopt from CSTR, the adoption donation goes toward the cost of caring for all of the dogs in the CSTR rescue program and can range from $100 - $350 depending on the dogs' age: | |
Crossroads Shih Tzu Rescue Disclaimer
There is absolutely no guarantee made or implied that any person requesting to adopt a dog being fostered through CSTR, or posted on the CSTR website, will be allowed to adopt a dog. Rather, all adoption applications are subject to acceptance based on a review process that may require collecting information from references and visiting the applicant's home. All decisions on placing dogs in adoptive and foster homes are based solely on the judgment of the volunteers and coordinators of Crossroads Shih Tzu Rescue, Inc. Adoption applications submitted through this form may be denied for various reasons. CSTR reserves the right to make all decisions regarding placement or final disposition of any rescued dog in its care whether in, or being placed in, a foster or adoptive home or other facility.
By submitting your completed application to Crossroads Shih Tzu Rescue, you attest that you have read the above disclaimer and agree to the terms therein. Furthermore you represent that the information you have provided on this form is the truth to the best of your knowledge and belief.
I hereby forever release, discharge, and agree to hold harmless and indemnify Crossroads Shih Tzu Rescue, Inc.; its board of directors; and its members, Officers, and agents from all claims, demands, actions, causes of action, or liability of any kind whatsoever arising as a result of or in connection with the fostering or adoption of a dog sponsored by this organization.
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