mellissa-yorkie.com

YORKIE ADOPTION APPLICATION FORM

This application is intended for those who are interested in adopting a dog from Mellissa Yorkie. Most of the dogs we rescue are seniors, but occasionally we have younger dogs available. If the dog you are interested in adopting isn’t a senior, some of the questions might not apply.

Dog Information

First Name *

Last Name

Phone Number *

Email Address *

City *

State/Province

ZIP / Postal Code

Preferred Method of Contact *Phone!Email!Text!

Type of Home *HouseApartmentCondoOther

Do You? *Own?Rent?

If renting, landlord name & phone: *

Is your yard fenced? *Yes!No!

Number of people in household? *

List ages of children (if any) *

Does anyone in the home have pet allergies? *Yes!No!

Do you currently have pets? *Yes!No!

Checkbox *Option 1Option 2

If yes, list them below *

Are your pets vaccinated? *Yes!No!

How many hours per day will the dog be alone? *

Where will the dog stay during the day? *InsideOutsideCrateDog Room

Where will the dog sleep at night? *

Who will be the primary caregiver for the dog? *

What will happen to the dog if you travel? *

What happened to your previous pets? *

Are you familiar with grooming needs of small breeds like Yorkies? *Yes!No!

Do you have a vet? *Yes!No!

Veterinarian Name: *Yes!No!

To ensure the dog is placed in a responsible and committed home, a rehoming fee and deposit policy applies. *Rehoming Fee: Total rehoming fee for the dog:$350.00

A deposit is required to reserve the dog once your application has been approved. *Deposit Amount:$100.00

Deposit Terms *The deposit secures the dog for the approved adopter.The deposit will be applied toward the total rehoming fee.The remaining balance must be paid before or at the time of pickup/delivery.

Deposit is refundable if the owner cancels the adoption. *Deposit Options Accepted payment methods include:CashAppApple PayChimeZelle

Agreement *Signature(your name):

By signing below, I certify that the information provided is accurate. I understand that providing false information may result in denial of adoption.

Date *