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PEKINGESE CHARITABLE FOUNDATION RESCUE PROGRAM – APPLICATION FOR ADOPTION
City, State, Zip _______________________________________________________________
Telephone, Fax, E-Mail_________________________________________________________________
Type of Pekingese requested by applicant: Use separate paper as necessary to answer any
(We very rarely get puppies and seldom dogs under 1 yr old)
Are you willing to accept a dog other than your primary choice? Yes ____ No ____
Has applicant previously owned a Pekingese? YES___________NO___________
Are you familiar with the needs of a Pekingese? Yes ___ No ___ Are you willing to work
with one of our volunteers or another professional to learn more about this breed? Yes
____ No ____
Tell us about your household and why have you chosen a Pekingese?
What role will the dog fill for you?
Does everyone in your family want a Pekingese Yes ____ No ____ If no, who is the person
how and do you plan to make a safe and fair transition for all concerned if this dog
comes to live with you?
Are there children in the household? YES_____NO_____ What are their ages? __________ Have
they been taught to respect animals? Yes ____ No ____
Are there other pets in the household? YES____ NO ____ Are they neutered or spayed? Yes
____ No ____
Do you rent or are you buying your home? _____________ If renting, is your landlord
agreeable to you having this dog? Yes ____ No ____
Landlord’s Name: ______________________ Landlord’s Phone #: ______________
How long have you lived at this residence? ______________ Do you plan to move in the near
future? Yes ____ No ____ What will you do with your pet(s)? ____________________________
What if the new facility doesn’t allow pets? _________________________________If your
life circumstances change?
Are you acquainted with a nearby Veterinarian? YES___________NO___________
Veterinarian's name and phone number? _____________________________________
One other reference who knows how you relate to dogs:
Do we have permission to contact your veterinarian,your reference and your landlord? Yes
____ NO ____
PCA Adoption Application – page 2
Are you familiar with laws governing dog ownership in your community? Yes ____ No ____
Do you have a fenced in yard? YES____ NO ____ Please describe the enclosure. If not, how
do you plan to exercise your dog and allow them to eliminate outdoors?
Are you willing to install a fence or dog run? Yes ___ No ___
Will your Pekingese be left outdoors unattended for any period of time? Yes ____ No ____
Under what circumstances?
Will someone be at home during the day? YES_____________NO______________
What accommodations will you make for your Pekingese if you’re away overnight or away on
Where will your dog be kept during the day? _____________________________ Night?
_____________________________ While you’re away? _______________________
Who will be responsible for your Pekingese’s upkeep: training , grooming, feeding, vet
visits, exercise? ________________________________________________
Are you prepared to make a lifetime commitment to this dog? Yes ___ No ____
ALL animals add to the housework. Are you prepared to do the extra work once the dog is
placed in your home? Yes ___ No ___
ALL animals need some time to adjust to their new surrounding; especially when other
animals are involved. Are you prepared to devote extra time and/or training in the
beginning? Yes ____ No ____
Until your pet learns the rules of your home, your Pekingese may urinate/defecate in your
home, and may chew household items. Are you willing to accept this and how will you
When you discipline your Pekingese, how will you do it?
Please add any comments that may help us in our decision.
A non refundable adoption fee of One Hundred ($100.00 to $175.00) to One Hundred Seventy
Five dollars is required for each Pekingese adopted, unless other arrangements are deemed
correct. This fee is to cover cost of medical care prior to adoption, and should be sent
to the PCF Rescue Fund, in care of the Treasurer. We assure the applicant that, to the
best of our knowledge, the adopted Pekingese was evaluated by a Doctor of Veterinary
Medicine, de-wormed, neuter/spayed, checked for heartworm, and immunized (including
rabies). If the adopter is unable to keep the animal, it is to be returned to
Referred By ____________________________________________________________________
Signature ____________________________________________ Date: _______________
OFFICE USE ONLY:
Application taken by: ____________________________________________ Date: _______
Application approved: _______________ Denied: ___________________ Date: _______
Reason(s) for denial: ________________________________________________
Comments by rescue staff person: ____________________________________________
this application may be printed, filled out and mailed or copied to Word, fill out in Word and attached to
9545 Johnnycake Ridge Road, Mentor, Oh 44060-7117
440 255-2200 email@example.com