Shih Tzu and Japanese Chin Rescue

Royal Oak, Michigan


Email Address:
Zip Code
Home Phone
Cell Phone
Number of people living in household
Tell us the name, age and sex of each member of your household, including yourself.
Does anyone in your household smoke? (Some pug nose dogs do have respiratory problems with second hand smoke.)
Are you expecting a child, or planning a family in the future? (Many toy breeds and Shih Tzu are not good with small children and we would not want to place a dog who didn't like children with anyone who was planning a family.)
If you are interested in a particular dog, please tell us the dogs name and your application will be forwarded to the family fostering that dog.
If you have you applied with any other rescue group(s) to adopt, please list the group(s) and contact person(s).
If the dog you are applying to adopt is not fostered locally, are you willing to travel to pick up your new family member? Yes
Depends on where
Are you willing to accept a dog with special medical needs, such as eye drops or a special diet or a daily medication?
Please explain any reservations or limitations you might have with regard to medical needs.
Are you willing to accept a dog with a history of neglect/abuse who needs extra love and attention and may take extra time to adjust to your household or is especially fearful of new situations?
Please explain any reservations or limitations you might have.
Would you consider a mix breed such as Shih Tzu/Poodle? Yes
Have you previously owned a Shih Tzu or high maintenance dog? Yes
What do you like about the Shih Tzu?
Describe what you feel are characteristics for the ideal dog for your family.
Are you prepared to pay someone up to $40 or more ever 4 to 6 weeks to groom your dog? Or are you prepared to purchase a grooming table, clippers, scissors and other accessories to devote the time to learn to groom your dog yourself?
Are you willing to spend time each day brushing and combing out your Shih Tzu? This additional maintenance is required whether the dog is being professionally groomed or you are grooming the dog yourself.
Are you willing to pluck the hair from the inside of the ears monthly to prevent infections?
Are you willing to clean the eyes of accumulated matter daily if necessary?
Which of the following best describes your home?
If you are a renter, does your lease or homeowners association restrict pet ownership?
Does your town or city have any restrictions on the number of dogs you can have?
Is your yard, or a portion of your yard, securely fenced? Yes
If you have a pool, is it fenced? Yes
Not applicable
If you have a dog run, is it secure? Yes
Approximately how many hours a day will your new dog be alone?
How long will the dog be left outside?
Where will your dog stay when left alone?
Where will your dog sleep at night?
Do you travel frequently, and if so, who will take care of your dog when you are away?
Does everyone in the family want a new dog?
Does anyone in the household have any known allergies to animals? Yes
How will you handle disciplining your dog?
What will you do if your spouse, children or other pets don't get along with your new dog?
What animals currently live in the household? (Please list type of animal, sex, altered or not, age and how long you have owned them, and whether they are inside or outside animals.
Please lists the pets you have owned in the past 10 years, name, breed, how long owned, explain what happened to it, including the age it died or left you.
Please list the names and telephone numbers of three references, including a veterinarian and groomer you use currently or have used in the past. We cannot process your application if you do not provide the contact information for your references.
All of the information I have provided is true and complete to the best of my knowledge. Signature of Applicant:
Date of Application:

Form provided by Freedback.