Rescue Information Form

Thank you for your interest in adopting a Tibetan Terrier through Rescue.

At this time, fortunately for the breed, there are more people interested in adopting a Tibetan Terrier than there are Tibetan Terriers to be placed. We try very hard to match the "right" dog with the "right" owner. To facilitate this, it would be helpful to us if you would answer the following questions below. There are no "right" and "wrong" answers; the questions are merely a guide to help determine your priorities and to help us select the best new owners for a rescue dog\'s new home based on the Rescue Committee\'s knowledge of the rescue dogs background from either the previous owners or those who have provided foster care.

Fill in the blanks below, and when you hit the "Submit" button at the bottom of the page, your data will be presented to you in a format suitable for printing, so you can print a copy for your own records. In addition, the form will be automatically delivered to the Rescue committee for their consideration.

Contact Information

Name:
Address:
Address2: (optional)
City:	State: Zip:
Telephone (day):
Telephone (evening)
Email:

Why Rescue:

What do you find appealing about the Tibetan Terrier and makes you want to adopt one over another breed?
Why are you interested in adopting a rescue Tibetan Terrier rather than purchasing one from a breeder?
How far are you willing to travel to go to see/pick up a dog?
If you get a Tibetan Terrier, can you think of any situations that would cause you to not be able to keep the dog?
If you were unable to keep the dog, would you be willing to return him to the TTCA Rescue Program?
How did you hear about the Tibetan Terrier Club of America Rescue Program?

The New Family

Please list the members of your household and their ages:
Does everyone in the household approve of adopting a dog through rescue?	Yes No
What other people that your dog will likely come in contact with on a regular basis? (For example, children/grandchildren not listed above, clients, maid/nurse other household help, etc.)
Who will be the primary caretaker of the dog?
How much time will be spent with the dog on a daily basis?
Have you been convicted of animal cruelty, neglect, or abuse?	Yes No
Have you been convicted under any animal control law?	Yes No
Do you live in a:	house condominium or apartment?
Do you	own or rent
If you rent, does your lease allow dogs?	Yes No Not Applicable
Are there any restrictions as on pets (size, weight, etc.) -- either your own or those of your landlord, community, etc.	Yes No
Are you aware of any restrictions/licensing requirements in your town?	Yes No
Where will the dog be kept during the day?
Will someone be home with the dog during the day? Approximately how many hours each day will your dog normally be left alone?	Yes No
Where will the dog be kept at night?
Will the dog normally have access to the entire house? Do you plan to use a crate or restrict the dog to a limited area and, if so, for what period of time(s)? Do you plan to keep the dog outside?
Do you have a fenced yard or do you intend to leash walk the dog? If you have a fenced yard, please describe the fencing (height, type, etc.). If you intend to leash walk, how many times a day or when during the day do you expect to take the dog for a walk?
Do you have any other pets? If so, please describe (type of animal, breed if applicable, age, spayed/neutered, etc.)
Have you ever had a dog before? If so, what kind? What happened to the dog? If you were unable to keep the dog, why?	Yes No
Have you ever obedience trained a dog? Are you planning on attending obedience classes or to obedience train your rescue dog?	Yes No Yes No
How often do you intend to groom a dog? Do you intend to groom yourself or to send the dog to a professional groomer?
What are you looking for in a rescue dog? (Family companion, watchdog, obedience/agility prospect, etc.)
Do you have any preferences as to age or sex, or is this unimportant? Any other requirements (good with kids, good with livestock, good with other pets, good with the elderly, travels well, able to jog with owner, high energy/low energy, etc.)?
Are you willing to take a dog with special needs such as a dog that needs to take daily medication, or that is in need of training? Are you willing to take a dog that has not been housebroken? If you adopt a TT that is found to have problems after you adopt him would you be willing to keep him/her and work through the problems or would you want to return him to Rescue?

Necessary Business:

The TTCA Rescue program must pay for the expenses involved which may include boarding, grooming, veterinary, administrative expenses and other costs involved in retrieving and placing not only your dog but others. Therefore, except in very unusual cases, a donation to TTCA Rescue is required when a dog is placed. Are you willing and able to contribute?
Will you permit a rescue volunteer to visit your home?	Yes No

By pressing the "Submit" button below, I declare that the above is true to the best of my knowledge and ability. I understand that the completion of this form does not guarantee my receipt of a Tibetan Terrier. I understand that I will not be contacted unless there is a dog available in my area which the TTCA Rescue believes may be suitable for me.

When you press the Submit button above, you will be presented with a copy of your input data in a form suitable for printing, so you can print a hard copy for your records. In addition, a copy will be sent to the Rescue committee for their consideration.

Once we receive your information, we will keep your name/answers on file in the event that a Tibetan Terrier becomes available that we believe would fit in well with your situation. If such a dog is or becomes available, we will contact you for additional information as well as to further discuss the adoption process/fees etc. Of course, if you have any further questions at this or any time, please feel free to contact us at this email address.

Again, thank you for your interest in Tibetan Terrier Rescue!

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Form Revised Jan 2003