Car-Mir-Jac Yorkies Adoption Application
Name___________________________________________
Address_________________________________________
__________________________________________
Email Address_____________________________________
Phones___________________________________________
1. Please indicate your reasons for wanting a Yorkie.
❑ Family Pet ❑ Adult Companion ❑
Companion for another pet ❑ Childʼs pet
❑
Other, explain____________________________________________________
_______________________________________________________________
2. What is your current living situation?
❑ Own House ❑ Rent House
❑ Apartment ❑ Parentʼs home
If renting verify landlordʼs
name and phone ________________________________
________________________________
3. How long have you lived at this address?_______________
4. Who
will be the primary caregiver?_____________________________________
5. How many hours a day will the puppy be
left alone?______________
6. Have you ever had a Yorkie before? ❑no
❑yes
7. Have you ever had another breed of dog? ❑ no ❑ yes, name breed_____________
Do you currently have any other pets? ❑no ❑yes, please list__________________
____________________________________________________________________
8. Please give three
references with phone numbers including one veterinarian that you have
used in the past or will use.
__________________________________________________________________________
__________________________________________________________________________
________________________________________________________________________
9. Do you have a fenced in back yard ❑ no ❑ yes
10.
Do you have any children that live in your home? ❑ no ❑ yes
ages ____________________________________________________________________
11. Are you capable of paying for vet
exams, vaccinations, and continued care? ❑ no ❑ yes
12. Have you ever returned
a dog? If so why? ❑ no ❑ yes _________________________
___________________________________________________________________________
13. Are you wanting a male or female?
❑ male ❑ female
14. Are you planning to breed? ❑ no
❑ yes
15. What are your main reasons for wanting a Yorkie over any other breed of dog?
_________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Circle your
expectations for your Yorkie puppy? What size as an
adult are you wanting?
Do you want a low energy lap dog
❑ under 3 lbs.
High energy and very active
❑ 3-4 lbs.
Quiet, mellow, calm, outgoing, social
❑ 4-6 lbs.
Purse puppy
❑ 6-7 lbs.
A little diva
❑ larger
Please fill out and fax or mail to:
Cheryl Nims
190 SE 45th Road
Lamar, MO 64759
Fax 417 681-0092
