PLEASE PRINT OUT THIS APPLICATION AND MAIL

The pug you may adopt from us will be medically current for one year during
which time you should not incur additional routine medical expenses with the
exception of heartworm preventative. Our objective is to ensure that your PUG
is healthy and disease free. To that end, PRDV has paid  for all medical procedures such as fecal check and, if positive, worming; heartworm check;
physical; shots (DHLP, rabies, parvo, corona); and specific procedures for
individual dogs (see your PUG'S history sheet for breakdown of procedures/expenses). To help us continue our work, we ask for a donation
in accordance with the attached schedule and for reimbursement of 50% of the
medical expenses. PRDV is a non-profit group of volunteers who donate
services, money and time to help these little ones enter permanent homes
as healthy, happy and loving members.

Applicant_________________________  Referred to PRDV by____________________

Applicants Address ________________________________________________________

Telephone number_______________________

Applicant's employer _____________________Telephone number________________

Describe in detail PUG you want (size, color, sex, age, etc.)
_________________________________________________________________________

_________________________________________________________________________
Why do you want this dog ? companion, gift, _________________________________________________________________________

Describe residence, house, apartment, duplex, townhouse;    own or rent
_________________________________________________________________________

Do you have fenced in yard ?  Yes  No      Number of adults in house____________ 
 
Children, provide ages _________________________________________________________________________

Do all residents approve of adoption ?  Yes  No

Who will be responsible for pet? ___________________________________________

Anyone home during day?  Yes  No          Who?________________________________

Hours pet will be alone ?  Where will pet stay during the day ?    At night? _________________________________________________________________________

_________________________________________________________________________
Have you ever owned a PUG or other brachycephalic (squashed face) breed before?    Yes  No
Explain status._________________________________________________________

Are you familiar with the PUG, temperament, grooming, environment ?  Yes   No

What is your opinion of neutering an animal ?
_________________________________________________________________________

_________________________________________________________________________
Who will care for this pet while you are on vacation?
_________________________________________________________________________  What will you do with pet if you move?
_________________________________________________________________________

Name / address of Veterinarian
_________________________________________________________________________                                            
Veterinarian's telephone number______________________

Signature______________________________          Date___/___/___

Please Fill Out Completely and Mail To: