If you are ready to adopt a Yorkie, please fill out the form below with as much information as possible. The more information we have, the better we can determine if your home is a perfect home for a Yorkie.
| Name |
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| Age |
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| Spouse |
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| Age |
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| Address |
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| Apt/Suite/No. |
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| City |
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| State | Zip |
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| Email |
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| Phone |
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| Work Phone |
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| Employer |
| Position |
| Spouse's Employer |
| Position |
| Number of Children |
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| Ages (separate with comma) |
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| Is everyone in agreement on adopting a Yorkshire Terrier? |
Yes | No |
| If not, why? |
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| How long have you lived at this address? |
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| Which best describes your current living situation? |
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| If you rent, please enter your landlord's name |
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& Phone:
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| If less than two years, please list your previous address: |
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| What type of environment? |
City | Suburban | Country |
| Besides your immediate family, are there others residing at your home? |
Yes | No |
| What are their names and ages? |
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| Does your family have a yard? |
Yes | No |
| Is there a fence? |
Yes | No |
| What kind of fence? |
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| How tall? |
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| Is it secured underground as well? |
Yes | No |
ADOPTION INFORMATION
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| Is someone home during the day? |
Yes | No |
| If not, where will the dog stay while you are gone? |
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| Where will your dog be most of the time? |
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| We will only place our Yorkies in homes planning to allow the dog to live inside. Do you understand this requirement? |
Yes | No |
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What will the living arrangements be for your dog most of the time?
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Other:
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| Does your home have a yard? |
Yes | No |
| Is the yard fenced? |
Yes | No |
| What type of fence/How tall? |
/ |
| Will the fence be locked when the dog is outside? |
Yes | No |
| Is the fence secured underground as well? |
Yes | No |
| Do you agree to spay or neuter this dog if it has not been done already? |
Yes | No |
| Will you take your dog to obedience class? |
Yes | No |
| Which trainer do you plan to use? |
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| Have you ever owned a Yorkie? |
Yes | No |
| Where is that Yorkie now? |
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| Do you prefer a male or female Yorkie? |
Male | Female |
| Age range? |
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| Is there a dog on our web page that you are interesed in? |
Yes | No |
| Which one? |
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| Why do you want a Yorkie? |
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| What activities do you plan to do with your Yorkie? |
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| How many years do you plan to keep the dog? |
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| Under what circumstances would you give up your dog? |
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OTHER PET INFORMATION
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| Do you have other pets? |
Yes | No |
| If yes, please list breed, age, sex: |
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| Are any current or previous pets from a rescue situation? |
Yes | No |
| Explain: |
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| Are your other pets current on all vaccinations? |
Yes | No |
| Are your other pets spayed/neutered? |
Yes | No |
| Are your animals on heartworm preventative? |
Yes | No |
| If yes, what type? |
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| Are you willing to pay for a YEARLY heartworm test? |
Yes | No |
| Are your animals on flea preventative? |
Yes | No |
| What type? |
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| Are you willing to provide flea preventative for your Yorkie? |
Yes | No |
| Are you willing to pay for yearly dental cleaning/care for your Yorkie? |
Yes | No |
| Are you willing to pay for yearly veterinary checkups for your Yorkie? |
Yes | No |
| Veterinarian's Name & Phone | Number: |
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| Name of animals and owner’s name registered with this vet: |
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| If applicable, approximate date of your current pet's last office visit: |
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| List the pets have you owned in the past ten years and what happened to them: |
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| How did you hear about Yorkshire Terrier Rescue Network? |
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| List any Humane Societies, Organizations, Breed or Training Clubs you are associated with: |
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| We will attempt to provide you with an honest evaluation of temperament of any dog we place. Do you realize that often the complete history of a Yorkie may not be known and you may encounter some behavioral problems? |
Yes | No |
| Are you willing to work with us on correcting these problems? |
Yes | No |
| Please provide the name, address and phone number of three references: |
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| Please enter any additional comments/questions: |
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| By clicking "Submit" below, I certify that the information provided on this form is true & correct. I am also financially and physically able to care for this animal.
I understand that proper food and veterinarian care may be costly, and that I am able to meet these requirements.
Home checks are made on a random basis following or prior to adoption. If upon inspection we find that information contained in this application to be false, we retain the right to turn down or remove the animal from your premises without a refund of moneys paid.
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