CCRT Adoption Application

Full Name:   

Address:

City:

Province:    - Select Province - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon   Postal Code:  

If you are in a rural locale, the nearest major city:

Email:

Phone Number(s) with area code:

Home:     Alternate:  

Occupation:  

Please check the appropriate age category:
(if under 18, you must have a parent/guardian's consent)

  Under 18
  Age 18 to 25
  Age 26 to 40
  Age 41 to 65
  Over 66

Name of current veterinarian (for animals you have now or have had in the past 4 years):   

Address:   

Vet's contact information including phone number with area code:  

Please provide 2 personal references that we may contact in relation to your application. They must be unrelated to and not live with you.

First Reference:

Name:  

Relationship:  

Phone:       Email:   

Second Reference

Name:   

Relationship:   

Phone:         Email:   

If you have already seen a specific dog you are interested in adopting please supply us with that dog's name:

If not, then please tell us about the Chihuahua you hope to adopt.

Preferred age:

Any Age
Up to 5 years
5 years and older

Preferred size of Chihuahua:

Any Size
Up to 6 pounds
6 to 10 pounds
Over 10 pounds

Gender of Chihauhua:

No preference
Male
Female

Tell us about your household and why you are interested in adopting a Chihuahua from the CCRT:

How many hours a day will the dog be left alone?

Where will the dog be kept when alone? (please be specific i.e. crate, room, run of house etc.)

What kind of food will you feed your dog and what is your feeding plan?

How do you plan to housebreak the dog or allow it to eliminate if it's not already housebroken?

Do you have a yard that is fenced securely enough to contain a Chihuahua? If not, how will you exercise your dog and/or allow it to eliminate outdoors?

Do you currently own any other animals? (If not, please skip to next section)

  Yes:       No:

Please provide details of your animals such as type, name, breed, sex, age, etc.

Are your pets up to date on shots and heartworm prevention? Yes       No

If not, please explain the reason.

Are your pets spayed or neutered?

Yes       No

If not, please explain the reason.

Have you owned animals in the past, not listed above? Yes       No

If yes, please tell us why they are no longer with you:

Ran Away
Stolen
Sold
Lost
Given Away
Surrendered to shelter or rescue group
Euthanized
Died

Please provide details regarding the above that you feel is important to your application:

Have you ever been charged with or convicted of animal cruelty under any municipal, provincial/state or federal regulations or laws? Yes       No

Do you have any experience with rescued animals? If so, please explain.

Rescue dogs will go through a period of adjustment when entering their new forever home. For example, they may become extremely shy, somewhat aggressive or display other negative behaviour. They may also start ‘doing their business’ inside the house or may not eat at their regular meal times. Tell us how you plan to work with your new dog to ensure this adjustment is smooth and as trouble free as possible? 

Are there any children in your household? Yes      No

Number of children:    Ages of children: 

If you have children in the household, how much of the responsibility will your child be given for the care and management of the dog?

Maximum
Some
Minimal
None

How much adult supervision will be provided when the dog and child are together?

Maximum
Some
Minimal
None

Please list the names and ages of all co-habitants or others who frequently share your premises and/or fenced yard:

Tell us about your residence: Own      Rent

Single Family Home
Apartment or Condo
Townhouse or Garden Home
Farm
Mobile Home
Other

If you rent your home, please provide contact information for your landlord.
Should you be approved for fostering, the CCRT may communicate with them to ensure you are abiding by any pet rules or by-laws in your lease. (Please include name and phone number, including area code).

Are you willing to permit a home check by the CCRT?

Yes       No

Will you consider any Chihuahua (different from age, size or gender preference indicated above) that comes into rescue?
Yes       No

Will you consider a long distance adoption (adopting a Chihuahua from another city or province)?

Yes       No

Neither this application nor any other document, undertaking or agreement to be delivered by the undersigned furnished to CCRT in connection with this application contains or will contain any untrue statement of fact or omits or will omit to contain a fact necessary to make any statement not misleading. There has been no event or information not disclosed in writing to CCRT which could reasonably be expected to have an adverse effect on the health, comfort, safety or well-being of the rescue dog.

The CCRT charges an adoption fee and these fees help to cover the vet expenses incurred by the CCRT. All dogs are spayed/neutered, microchipped and up to date on vaccinations and heartworm preventative (if applicable) before ownership is transferred to an adoptive home.

I hereby certify that all statements made herein make full disclosure and are true. Should there be any change in the circumstances as stated above, I will notify the CCRT as soon as possible.

Yes I understand and agree       No I do not agree

Please indicate that you are now aware that your application must be approved before adoption of a Chihuahua can take place.
  Yes I understand and agree    

Please indicate whether you have read all the full application and understand its meaning and agree to its terms by clicking the button below.
Yes I have read this application and fully understand its meaning and agree to its terms

By submitting this application to the Canadian Chihuahua Rescue and Transport (CCRT), I agree and consent to the collection, use and transfer of my personal information for the purposes of processing my application. For information regarding the CCRT and its adherence to Canada's privacy laws (PIPEDA), please view our Privacy Policy by clicking here.

Submission Guidelines

All fields must be completed before submission.

Press the submit button once and wait for the results of your application. An automatically generated response will be sent to you to confirm that your application has been received by the CCRT.

The CCRT receives dozens of applications on a weekly basis and we ask for your patience as our volunteers make time to reply to you.

Thank you again for your interest in the CCRT.