KENTUCKY RESIDENT ONLINE
Street Address / Mailing Address
City / State / Zip
Daytime Phone (with Area Code)
Evening Phone (with Area Code)
*Please make sure that this email address is one that you check
regularly. Our initial contact with you will be via email. You may
want to check your junk mail folder, in case the unfamiliar address gets
sent to your junk mail. If you have not heard from us within two
weeks, please contact us.*
Adults in Household and their ages
Children in Household and their ages
Occupation of Adults
Are there likely to be any major lifestyle changes in the near future?
If any, please list. Examples: moving, expecting a child, caring
for an elderly relative in your home, etc.
Is there a member of your Household who doesn't want a
Pug or dislikes dogs?
Information About Your Residence
Type of dwelling?
Do you own or rent?
If you Rent, please provide the
Apartment Complex Name (if applicable),
your Landlord's name and phone
What area do you live in?
How long have you lived at your
Approximately how large is your yard?
Is your yard fenced?
If Yes, what type of fence and how tall?
If No, do you plan on adding a fence for your Pug?
If you have no fence and no plans to
add one, how will
you ensure that your
Pug will get adequate exercise and
play time outside?
Do you have a pool or a hot tub?
If Yes, is the pool or hot tub securely fenced in so
that the Pug will not have access to it?
Will your pug have to climb any stairs over 1 inch in
Does your home have air conditioning?
Where will your Pug sleep at night?
Do you plan to use a crate for your Pug to stay in
when you aren't at home?
Please explain why or why not.
Do you plan on keeping your Pug mainly indoors or
outdoors? Please explain.
Information About Current Pets
Please list all current pets,
including - name of pet,
type of pet, breed,
age, sex, ,
and if they stay
indoors or outdoors.
If your pet is not
please give the reason. Thank you!
Do you own cats? If yes, are they declawed?
Where did you get your current pets?
newspaper ad, breeder, animal shelter, etc.
If you have dogs, are you involved in
with them? If Yes, what type of activities?
If you have dogs/cats - What type of heartworm preventative are they on?
If you have dogs/cats - What type of flea control do you use?
If you have dogs/cats - What type of food do you feed?
When you are not at home, where do your dogs stay?
certain area of house
Free run of
Do you consider your current pet(s) to
towards people or other animals?
If yes, please explain.
Past History with Pets
Please list all past pets, including -
type of pet, breed,
amount of time owned,
where kept, spay/neuter status,
and where the pet is now and explanation.
Have you ever owned a Pug?
If Yes, where did you get your Pug?
If you have ever had to give up a pet, please explain.
Please list the Name, Address
of your current veterinarian. and
If you have no current pets,
please list the information for your most recent
Your application will not be processed
without this information.
You will also need to let your Vet know that
Kentuckiana Pug Rescue will be contacting them and give your Vet
authorization to release information to KPR.
General Pug Information
Are you aware of the health problems
that Pugs can have?
Please list the health problem you are aware of.
Are you willing to take care of any
that may occur after adoption of your Pug?
Do you know that Pugs shed 365 days a
Do you know Pugs snore?
Pugs can live to be 14+ years old.
Are you willing to
have a Pug be a part of your life for that amount of time?
What types of behaviors do you expect
from your Pug?
What amount of time and effort do you
plan to devote
to your Pug each week?
Do you plan to enroll your Pug in
What family members will assist in
exercising and feeding the Pug?
What is your definition of
disciplining a dog?
Do you have any training objectives
for your Pug?
Type of Pug you would like to adopt?
What color Pug do you which to adopt?
What age preference do you have for
Less than 1
year old (very rare in rescue)
1 - 6 years
What sex do you prefer to adopt?
Would you adopt a Pug mix?
Would you adopt a bonded pair of Pugs
been together their entire lives?
Are you willing to financially care
for your Pug's health
throughout his/her lifetime?
Are you willing to have a home visit
Are you willing to return your Pug to
Kentuckiana Pug Rescue should
any problems arise that force you
to no longer care for your Pug?
Is this Pug for someone else?
Would you be willing to adopt a
special needs Pug?
If Yes, please state which special
needs you would be
willing to accept.
(Blindness, Deafness, Lameness,
On medication full time)
Please give any additional information
you feel would be helpful to Kentuckiana Pug Rescue?
Please list the Names, Addresses and
of 3 References.
( Important: At least 2 of these
can NOT be relatives.)
Reference # 1
Reference # 2
Reference # 3
How did you learn about Kentuckiana Pug Rescue?
(internet search, friend, veterinarian, etc.)