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 ❑ Child’s pet ❑ Other, explain____________________________________________________ _______________________________________________________________ 2. What is your current living situation? ❑ Own House ❑ Rent House ❑ Apartment ❑ Parent’s home If renting verify landlord’s 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__________________ ____________________________________________________________________ 7. Please give three references with phone numbers including one veterinarian that you have used in the past or will use. __________________________________________________________________________ __________________________________________________________________________ ___________________________________________________________________________ 8. Do you have a fenced in back yard ❑ no ❑ yes 9. Do you have any children that live in your home? ❑ no ❑ yes ages ____________________________________________________________________ 10. Are you capable of paying for vet exams, vaccinations, and continued care? ❑ no ❑ yes 11. Have you ever returned a dog? If so why? ❑ no ❑ yes _________________________ ___________________________________________________________________________ 12. Are you wanting a male or female? ❑ male ❑ female 13. Are you planning to breed? ❑ no ❑ yes 14. What are your main reasons for wanting a Yorkie over any other breed of dog? _________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ What are 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 | 
