I am interested in the following: (click all that apply)	Male Female Young Adult Adult Senior Special Needs
Are you interested in a specific yorkie we have on our site? If so list the name of the dog(s).
What is your FIRST and LAST name?
YOUR age (if you leave blank your application will not be processed):
Email Address:
Street Address (include condo or Apt. # if applicable):
Town and State. (We only accept applications from the State of Florida)
Home, Work and Cell Phone Numbers:
Do you accept text messages? If so, type in the phone number that allows texts.
Occupation: If none, type in "none."
Name, age and occupation of spouse or significant other. If none type in "none."
Name and ages of anyone else residing in the home: (if none, type in "none." If box is left empty, an error will occur.)
Have you ever owned a Yorkie, Morkie or Maltese?	Yes No
How many hours during the day will the yorkie be left alone.
What is your work schedule? Is anyone in the household retired?
Will the yorkie be crated?	Yes No Not sure I will use an X-Pen I will use a Playpen. I will gate off in Kitchen. I will gate off in Laundry Room. I will gate off in Bathroom.
Where will your pet be kept when you are not home?
Where will your pet sleep at night?
Name & Phone # of the Veterinarian you use now or one you have had in the past.
How many dogs you you currently own now?
Describe them: Breed, Sex, Age, Weight and how long have you had them and are they spayed/neutured?
What do you currently feed your dog?
How many cats do you own?
Are your cats spayed/neutered?	Yes No Do not have cats
Do you own any other type of animals? If no, type in "none."
If you own other cats and dogs, are they current with all of their vaccinations?	Yes No
What happened to the pets you have had in the past. Click all that apply:	Died of old age Died of illness Died in an accident Ran away Had to give away Never owned a pet
If you ever had to give a pet away OR if your pet every died in an accident; please explain the circumstances:
Do you have a fenced in backyard?	Yes No Will install a fence Dog is walked on leash only.
Do you have a Swimming Pool or a Hot Tub?	Yes No
Does it have a safety fence around it?	Yes No Will get one if necessary
How long have you been at your current address?
Do you live in a:	Single House Town House Condo Apartment Duplex Mobil Home Boat Other
Do you own or lease?	I own I lease
If you have a Landlord do you have his permission to have a dog?	Do not have a landlord Yes No
Name and phone number of your Landlord if you are leasing.
Any restrictions on pets in your community?	Yes No Not sure
Are you planning on moving in the near future?	Yes No Unsure
If you move, what would you do with your pet?
Do you live in Florida year round? If not, please furnish us with your other address.
Please list 3 NON-RELATED personal references: Include name, address and phone number. Your application will not be processed without references listed.
Do you understand that often times the complete history of a rescue dog may not be known?	Yes No I only want to adopt a dog who's history is known.
Social/Behavioral problems you could not handle or would not want to correct: (Click all that apply)	Soiling Floors Chewing Biting Aggression towards Cats Aggression towards Dogs Excessive Barking Separation Anxiety Anti-social behavior The above does not concern me. I can handle it all!
Who will be responsible for the medical care and training of this animal?
Medical condition(s) you are not able to handle.
Are you willing to keep the dog for life?
Under what circumstances would you give up a dog?
If you are a senior citizen, who would take your pet if something happened to you?
Are you willing to work with housebreaking issues?	Yes No I want a dog that is totally housebroken.
What brand of Heartworm Preventative do you currently use? If none, type in "none."
What brand of Flea Control do you currently use? If none, type in "none."
There are times when unexpected and often very expensive medical conditions occur. What will you do if this happens to your pet?
Do you have any planned vacations or business trips coming up? If so, when?
Are you ready to adopt a dog now? If not please explain.
Do you have a Facebook page? If so, what name is it under?
Do you have an Instagram page? If so, what name is it under?
Type in any comments you wish to about you and your family that might help us match you with the perfect yorkie.
I, the undersigned, do hereby certify that the information above is truthful and correct: * The information I provide will be verified before I am approved for adoption. * Falsification or omission of any of the above information will result in automatic refusal of adoption or return of the pet to "Florida Yorkie Rescue." (please type in signature)
Date this application was sent in: