Adoption Application

Please fill out the form completely. Incomplete forms will be deleted. Please fill in your e-mail address and personal information. This information is private and will not be given out to anyone other then rescue representatives in order to contact you when a dog becomes available. We have been receiving a large numbers of applications. Our volunteers are working on them and it is taking a little longer than planned to get back to everyone due to the large number (1000) we have received as of today. Please be patient, we are working as fast as we can. And thank you so much for taking the time to complete the application and for your interest in adopting a yorkie

Press the 'send' button when you are done. For correction before sending, press 'oops' If the form isn't working, please just e-mail Us the information.

Depending on the dog and it's medical needs, a minimum $150 donation plus a $25 fee for Microchipping. Each dog is Microchipped before going to it's new home. Read about our Microchip Policy here. The adoption donation will be made to the Yorkshire Terrier National Rescue at the time of adoption. Thanks.

(Please don't use a P.O. Box for addresses, we need an actual location)

Please note: If you do not provide a valid Name, Address, E-mail, and other important information asked for in this form, you will be taken to an Error page and explained what fields are missing. Once you fill in all the required information, we will let you know that your form has gone through.

Your Name: Your address:

City: State: Zip Code:

Home phone: Work phone: Cell phone:

E-mail:

Ever had a Yorkie:

If yes, how long:

What happened to it:

Do you have Children:

If Yes how many and their ages:

What experience do the kids have caring for dogs:

Does anyone in the family have an allergy to animals:

Do you have other pets:

If yes, What type of pet, ages, and time with your family:

If a dog, what age, sex, and is it fixed:

Previous dogs, what breed and what became of them:

Do you have a local Vet:

if yes, please give name, address, and phone number:

Can we contact your Vet for a reference:

Please list 2 personal references,
preferable living on your street

Reference 1
Name: Address:

City: State: Zip:

Phone: E-mail:

Reference 2
Name: Address:

City: State: Zip:

Phone: E-mail:

Will you allow a Rescue Volunteer visit your home:

Will you be able to take your Yorkshire
Terrier through a basic obedience course:

Do you live in a house or apartment:

If an Apartment, will you agree
to walk your dog only on a leash:

(If renting, will require a letter from landlord,
stating that this yorkie is allowed)

Do you have a fenced in yard:

If yes, what material is the fence constructed:

If no, will you agree to enclose
a portion of your yard for the dog's safety:

Do you have a swimming pool:

If yes, do animals have free access to it:

How many hours a day will this rescue be left alone:

Where will you keep this rescue during the day:

If you go out of town for several days,
who will keep the dog for you:

Do you agree to provide all necessary
veterinary care for the dog including annual
booster vaccines, heartworm testing, heartworm
preventative and general health care:

Why do you want to adopt a Yorkie:

What age, size, gender do you prefer:

Addition Comments:

Press send only once!

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