In a few days, if you do not receive an acknowledgment that we have your application, please contact the Director, Nancy Beims at 303-289-2541 and we will work with you to get your information.

Date:

Name:
Address:
City:
State and Zip Code:
Phone: (with area code)
Home:
Work:
E-mail address:
D/O/B:
Occupation:
Name of Employer:

Name:
E-mail address:
Occupation:
Work Phone:
D/O/B:

Name(s):
Age(s):
Relationship to you:

Has anyone in your immediate family/household ever been convicted of a charge related to child abuse or cruelty to animals?

Is there any such charge pending?

If yes to any of the above, please explain and give disposition of charge.

Which of the following best describes your current residence? (home, condo, apt., etc.)
Do you own or rent?

If renting do you have your landlord’s permission to keep dog(s)?

Name and Telephone number of landlord:

How long have you lived at the above address:

If you have a yard, is your yard securely fenced?

If you do not have a securely fenced yard, how will you exercise, confine, and provide for
your dog(s) need to eliminate?

Do you have a doggie door?

Does anyone in your household smoke? (Some pug nosed dogs do have respiratory problems with second had smoke).

Does everyone in the family want a new dog?

Name(s):
Species:
Breed:
Sex Neutered/Spayed:
Age when where did you get him/her?

Where are they kept when you are gone? (i.e., indoors, outdoors, both)

Are they up to date on vaccines?

What do you feed your dog?

Name and telephone number of current or previous veterinarian.

Name:       
Species:
Breed:
Sex:
How long did you have him/her?

What happened to your pet?

Have you ever sold, given away and/or surrendered a pet(s) of yours?

If yes, why?

Please give us two references with dogs that we can contact for information about how you interact with animals. Please list people you know well that can tell us why you would be a perfect owner.

Name:
Email:
Daytime Phone:
Evening number:

Name:
Email:
Daytime Phone:
Evening number:

How many hours per day will your dog be on its own?

Where will your dog stay when no one is home?

Where will your dog be when you are at home?

Where will your dog sleep at night?

Do you travel frequently?

If yes, who will care for your dog while you are away?

Why do you believe that you will be able to provide an excellent home for this dog?

No dogs really come already housebroken. They may be trained to the foster’s routine, but not yours.  How will you housebreak your dog?

Can you afford to spend at least $800 to $1200 per year for food, routine medical care, grooming, and training your pet?

Are you willing to attend obedience classes with your new pet?

Do you object to the use of a crate or kennel, if necessary?   Please explain why or why not.

May we visit your home to verify the information you have provided?

What will you do with your dog(s) if you move?

Are you willing to restrict your choice of future housing to places where pets are allowed?

Is anyone in your household allergic to dogs? If yes, please explain.

What are the requirements for dog owners in your community (i.e., number of pets you may legally have, rabies vaccination, etc.)

What circumstances, in your mind, justify getting rid of a dog?

Why do you want a dog? Please elaborate.

Are you willing to accept a dog with special medical needs, such as eye drops, special diet, or daily medication?  Please explain any reservations or limitations that you may have.

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 ir especially fearful of new situations?  Please explain any reservations or limitations you might have.

Are you willing to accept a dog with behavior problems who requires special training, such as housetraining, toy or food aggression, or needing to be the only dog?  Please explain any reservations or limitations you might have.

Please give the name, address and phone number of your current groomer or a groomer you used in the past with your previous pets.

The Shih Tzu, Maltese, and Lhasa Apso breeds are a high maintenance dog, and while you may love the breed you may discover that you do not have the time or the resources to devote to its upkeep.  Things to consider with a high maintenance dog are as follows:

     1.     Prepared to pay $40.00 or more for professional grooming every 4 to 6 weeks?

     2.     If not, are you prepared to buy a grooming table, clippers, scissors, and other accessories, and devote the time to learn to groom these breeds?

     3.     Willing to spend 1 hour each week brushing and combing the dog(s)? (This will be required even if you do use a groomer).

     4.     Willing to pluck the inside of the ears monthly to prevent infections and to clean the eyes of accumulated matter daily, if necessary?

List the dog(s) by name (currently available site), that you might like to adopt. We will try to help you determine which dog will fit into your lifestyle best.

Please list your preference regarding sex of dog: (i.e., M or F or No preference)

What age range are you interested in?

Will you consider something other than your preference?

Why do you want the breed that you have chosen?

Have you done any research with regard to this breed?

Shih Tzu, Maltese, and Lhasa Apsos can live to be 17, 18, even 20 years old. Adopting a dog is a life-long commitment much like a child. They are dependent on you for their lives - they are not disposable possessions - so please consider this when you are applying.

Picture yourself in 15 years.  Imagine what your life style will be like.  Now, with that picture in mind, consider that you will be caring for an older, deaf, blind and possibly incontinent dog.  Explain why you think you can make the commitment to care for this little dog with the same love and devotion that he/she has given you for the last 15 years?

What would happen to your dog if something happened to you within the next 15 years and you could no longer care for him/her? Who would care for your dog? Please provide the following information:

Name:
Address City/State/Zip Code
Home Phone and Email Address

What type of pet do they have now?

How does this person feel about taking responsibility for a dog that may be 14-15 years old at the time?

It’s often very costly to care for an elderly dog.  Are you willing to make a provision in your Will for the ongoing care of this dog? 

Picture the face of the sweet little dog you would like to adopt. Picture him sitting at your feet looking up at you with adoring eyes. Picture him noticing that you are looking and now he gets up and comes over to kiss your hand and ask for a pat on the head.  Do you feel the total love and adoration these little dogs can give? Understand that many of them have never been treated well, never known a kind pat on the head or a loving word from a human. They've only known suffering, pain, and neglect. Understand that once you adopt them, you ARE their life and if YOU don't do right by them, they will go to their death never knowing love.   Keep them safe, love them no matter what. Be patient, teach them right from wrong.  They will be your responsibility.  These little dogs thrive on tender loving care and will be a happy, fun, and loyal companion to you for the rest of your life.

Thank you for taking the time to complete this application. By submitting this application you attest to the truthfulness of your answers.   Falsification of any of the above information will be grounds to disallow your adoption of a rescued dog. 

Must be signed by applicant and co-applicant prior to application being considered and approved

I/WE HEREBY SWEAR THAT ALL OF THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY/OUR KNOWLEDGE.  SHOULD A DOG BE PLACED WITH ME/US, IT WILL RESIDE IN MY/OUR HOME AS A PET.  I/WE AGREE TO PROVIDE THE DOG WITH ADEQUATE FOOD, WATER, SHELTER, LOVE AND AFFECTION, TRAINING, IDENTIFICATION, AND MEDICAL CARE.  I ALSO UNDERSTAND AND AGREE THAT THE DOG WILL NEVER BE GIVEN TO A SHELTER, BUT IF FOR SOME UNFORESEEN REASON I/WE NEED TO FIND A DIFFERENT HOME FOR THE RESCUE DOG, I/WE WILL CONTACT THE RESCUE ORGANIZATION AND PLACE THE RESCUE DOG WITH SAME, SO THAT A SUITABLE HOME MAY BE FOUND FOR HIM OR HER.

____________________________________                      ____________________________________

Applicant Signature                                                            Co-Applicant Signature

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THIS SECTION FOR USE OF THE COLORADO SHIH TZU AND MALTESE RESCUE REPRESENTATIVE

Application:_______ Approved_________ Disapproved______ Withdrawn_____ Other_________

Name and phone number of CSTR Representative________________________________________________