Maltese Adoption Application

Confirm email address:

Street Address(must be physical address, no P.O. Box)

City/State/Zip

Home Phone

Work Phone

Why do you want to adopt a rescue ?

Age of Applicant:

Applicant's Occupation:

Spouse's Occupation (if applicable):

Please list the members of your household with the following information on each: Name, Sex, Age (if under 30), and relationship. If you live alone please put that information here.

What are your and your spouse's hobbies ?

Do all adults work full time?
YES NO

Approximately how many hours each day will your new dog be alone? (This means how many hours
will YOU or your Family be away from the dog)
--Select_One-- never/rarely 1 to 3 hours 4 to 6 hours 7 to 9 hours 10 to 12 hours

Where will the dog be kept when it is alone?

If you are ever away for a few days who takes care of your pet ?

Does anyone in your household have any known allergies to animals?
--Select_One-- Yes No

Are their other pets in your household? What kind? Size? Age? - Spayed/Neutered ?
(example:3 y.o. male neutered collie-60 lbs-owned 2 years-from shelter)

Have you a veterinarian you have used before and plan to use with your new dog?
--Select_One-- Yes No

What is the name, address and phone number for your veterinarian?

Have you a groomer you have used before and plan to use with your new dog?
YES NO

What is the name, address and phone number for your groomer?

Please list 2 personal (non related) references, with address and phone number for each. Also please let us know how long you have known them and if it is a personal or business friend.

Have you owned a dog before?
--Select_One-- Yes No

What happened to this dog ? (If your dog died of old age, please include the age
when he passed away.)

Do you live in a house, town house, apartment, duplex, condominium or other?
--Select_One-- House Town house Apartment Duplex Condominium

Do you rent or own?
--Select_One-- Rent Own

If you rent or lease, are you permitted to have an animal?
--Select_One-- Yes No

Do you have a fenced in yard?
--Select_One-- Yes No

IF you do have a fenced in yard, is this where the dog will go to use the bathroom ?
--Select_One-- Yes No

If the fenced back yard is not where the dog will potty, please explain why.

Please select the best description of your fence:
--Select_One-- Chain Link Wood Fence Stone

Other, if not listed what is the type of fence?

Does the fenced go around your back yard completely?
--Select_One-- Yes No

If there is no fence, how do you plan for the dog to relieve itself ?

How do you house train a dog ?

Do you have a dog door?
--Select_One-- Yes No

What breed are you wanting to adopt?
--Select_One-- Maltese bichon yorkshire Terrier shih tzu Chinese Crested westie pom Any Small Mixed Breed

Other breed, not listed above ?

Why do you want this breed ?

Size of dog (lbs)
UPDATE: For Adoption Fees please click hereAdoption Fees

Sex Preference:
--Select_One-- Male Female Either

What is the Oldest age you will accept?
UPDATE: For Adoption Fees please click hereAdoption Fees
--Select_One-- 1 to 3 years (fewer available) 4 to 6 years Over 6 years Any Age

Will you accept a dog that has been abused?
--Select_One-- Yes No

Will you accept a dog who has a treatable medical problems?
--select_one-- Yes No

Will you accept a dog who needs help with house training ?
--Select_One-- Yes No

What do you use for fleas on a dog ?

How do you prevent Heartworms in a dog ?

If you recently lost your dog please tell us how it happened. (ie, ran away, hit by car, etc.

When you adopt a dog you will be asked to sign an Adoption Contract and agree to future visits
for the first year. Do you agree to this ?
Yes No

We also require that you pay a fee of 160.00 or more to reimburse the rescue for spay/neuter and shots.
UPDATE: For Adoption Fees please click hereAdoption Fees
Yes No

If you are not able to pay the full fee for adoption, how much could you pay ?