The Questions Below Will Help Us Match Rescue Yorkies With The Right Homes. Please Answer Each Question As Completely as Possilbe.. Please Be Aware That Our Adoption Fee Is $300.00 Per Pet.

Are You 21 Years Old Or Older?

Yes
No

Your Name:

Your Home Address (NO P.O.Boxes)

City, State, And Zip:

Your Contact Phone #

Your Email Address:

Would You like To Adopt A Male Or Female?

Male
Female
No Preference

What Size Yorkie Are You Looking To Adopt?

Tiny 4-5 Lbs (NOT COMMONLY AT RESCUE)
Small 6-8 Lbs (Most Commonly At Rescue)
Medium Over 8 Lbs

What Age Would You Like To Adopt? WE RARELY GET DOGS UNDER A YEAR OLD

Young ( 1-3 Years Old)
Adult ( 3-6 Years Old)
Senior (Over 7 Years Old)

Have You Ever Owned A Yorkie?

Yes
No

Will Your Dog Be Groomed Every 4-6 Weeks?

Yes
No

Are You Prepared To Care For This Pet For 16+ Years?

Yes
No

How Many Adults Live In Your Household?

Do You Have Children? What Are Their Ages

If You Own Dog(s) What Type?

How Do You think Dog # 1 Will Respond To A New Dog?

Aggressive
Playful
Submissive
Fearful

How Do You think Dog # 2 Will Respond To A New Dog?

Aggressive
Playful
Submissive
Fearful

How Do You think Dog # 3 Will Respond To A New Dog?

Aggressive
Playful
Submissive
Fearful

Is/Are Your Current Dog(s) Spayed or Neutered?

Yes
No

Do You Have Any Other Pets?

Cat (s)
Bird (s)
Rabbit (s)
Ferret (s)
Snake (s)
Small Reptile (s) (Iguana ect)
Small Pet (s) (Rat, Mouse, Hampster ect)
Fish
No Other Pets

How You Ever "Given Away" A Pet Because: You Were Moving, Bored With It, Or Didnt Have Time To Care For It ?

Yes
No

Do You Rent Or Own Your Home ?

Rent / Lease
Own
Time Share

If You Rent, We Will Need Your Landlord's Name & Contact Info (We Will Check To Confirm You Can Have A Pet ~BEFORE YOU ADOPT~

Do You Have A Fenced Back Yard

Yes
No

What Type Of Fence Do You Have?

Chainlink
Block Wall
Wood
Wrought Iron
Professional Plastic Paneling
Other
No Fence

If You Have A Pool, Is It Gated Away From Pets?

Yes
No
I Do Not Have A Pool / Spa

Yorkie Are Indoor Dogs. Are You Willing To Keep Your New Pet Inside Your Home ?

All The Time
Sometimes
Unable To Keep Pet Inside

If Not Already Housebroken, Which Method Will Be Used To Housebreak This Pet ?

Piddle Pad
Belly Wrap
Housebroken
Does Not Need To Be Housebroken

Are You At Home at least 8 Hours A Day?

Yes
No
Sometimes

Where Will Your Dog Sleep At Night?

In Bedroom
Loose In Home
In A Confined Area
In A Crate
Outside

Where Will Your Dog Spend Time While Your Not At Home?

Confined Area Of Home
Loose In Home
In A Crate
Outside
Travel With You

All Cities & Counties Require Dogs To Have A Rabies Vaccine And To Be Licensed, Will You Abide By These Laws?

Yes
No

THIS FORM WILL SERVE AS YOUR ADOPTION CONTRACT, This is a LEGALLY Binding contact between The Adopter and Southern California Yorkie Rescue. I (The Adopter) declare that the information I have provided above is true and correct. I declare that I am financially capable of caring for a a rescue dog, This includes Annual Well Checks at the Vet, Emergency Vet Care, Grooming, Dental Care, and any other expense that can occur during this dog's life. DISCLAIMER: Because Southern California Yorkie Rescue has little or no knowledge of the rescue dog's past, Southern California Yorkie Rescue cannot guarantee Age, Temperament, or if any medical conditions exist. It is agreed and understood by the adopter that while every effort is made to provide accurate history and assessment of a dog, Southern California Yorkie Rescue does not warrant a dog regarding age, medical status, behavior or disposition. It is further agreed that environmental changes may effect and change the temperament of the above named dog and that Southern California Yorkie Rescue has no liability or responsibility of any nature regarding later defects with the dog, or injuries or damage to any person or property which may be caused by the dog. The adopter agrees to indemnify and hold harmless Southern California Yorkie Rescue and its members or representatives against any and all claims for any injury or property damage to the adopter or anyone else. This stated, IF THE ADOPTED DOG IS NOT WORKING OUT, THE ADOPTER (ONLY THE PERSON WHO HAS SIGNED AS THE ADOPTER) HAS 24 HOURS TO RETURN SAID ADOPTED DOG IN EXCHANGE FOR ANOTHER DOG EITHER AT THE SAME TIME OR AT A FUTURE DATE IF NO OTHER DOG IS CURRENTLY AVAILABLE. THE ADOPTION FEE IS NON REFUNDABLE. Dogs adopted from Southern California Yorkie Rescue SHALL NOT be relinquished (turned into) an animal shelter, The adopted dog shall be returned to Southern California Yorkie Rescue. This agreement entered into this date by and between Southern California Yorkie Rescue and the applicant, hereinafter refered to as 'The Adopter", for the adoption of the above identified dog. The adopter agrees to pay Southern California Yorkie Rescue a NON REFUNDABLE Adoption Fee of $300.00. The adopter agrees to provide the dog with a safe home with proper care and attention. The dog is not to ride loose in the back of an open bed pick up truck and will not be chained. This dog is not an outside pet. In the event Southern California Yorkie Rescue discovers the inhumane treatment of this dog, it is agreed Southern California Yorkie Rescue has the right to immediately take possession of the above named dog. The Adopter agrees to have this dog licensed in the city of residence and to not violate any laws or ordinances with the dog. It is agreed and understood by the adopter and Southern California Yorkie Rescue that this written agreement sets forth all promises, agreement, conditions, and understanding between them, oral or written, and that both parties have fully read and understand all of the agreement. This agreement shall inure to the benefit of and be binding upon the adopter and Southern California Yorkie Rescue and their successors or beneficiaries. In the event this contract, including all its covenants and conditions, is breached by the adopter, This dog may be removed from the adopter immediately.

Your Signature (Type Your Name)

Today's Date