JCCARE
Adoption Application and Questionnaire

Please read these instructions and review the Adoption Agreement before filling out this form.
 Important note: If you are using the Netscape browser, this form will probably not work. 

All JCCARE CHIN are spayed or neutered before being made available for adoption.

This questionnaire is intended as a guide to help you think about all the ways a Japanese Chin Rescue will impact your life and to help determine if a Japanese Chin is the right dog for you. All questions concern various aspects of ownership and should be given serious consideration before deciding to share your life with any dog. It is by no means a test which will be used to disqualify you from consideration for Chin adoption. Some of the questions may seem personal, and we assure you that all applicants answer the same questions, and all questions are used only to help us make the right match. After all, we want “forever homes” for Chin in need!
This form will take quite some time to complete. We strongly suggest that you read the form in it's entirety before beginning to fill in your information. You may want to print the form and think about your answers offline before typing them in. Once you submit your form, it will be emailed to Dana Baldinger for review.

Part One: Tell us about you and your family

Your name
 

How many people in your household? Please list all family members and include names and ages.
 

Address 1

Address 2

City

State

Zip

How would you describe your family in terms of lifestyle? Are you active, on the go, or more stay at home? Do you have a great many people visiting ? Do you have other animals that visit? Please explain.

Your Main Phone Number

Alternate Phone Number
 
Your email address
 Ideally, what role would your Chin play in family life (play with kids, cuddle adult owner, do therapy work)?


What type of home do you have? (single family house, apartment….)
(If you live in an apartment we need a letter on official letterhead from your landlord or a copy of your lease, plainly showing you are allowed to own dogs on premises.)
 
Does your lease or homeowners assoc. limit or restrict pet ownership?
 
Does your city or town limit the number of animals you may keep? To what number?
  		Is your yard, or a portion of your yard, securely fenced? If not, how do you intend to exercise your pet?
 
If you have a pool, is it fenced in?
  		Do you live on or near a busy road? What distance from road? How do you plan to keep your pet from it?
 

Part Two: Why a Japanese Chin?

Have you previously owned a Chin? If so, what do you like about this breed? If not, what attracted you to the Chin?
 
Have you considered other breeds? If so, which breeds and why? Please tell us if you have any preferences regarding age, sex, colour, etc. Keep in mind that the more open you are, the more likely you will have choices sooner. Note that we very seldom get puppies, and the average age of rescue Chin seems to be between 3 and 7 years.
 
Are you willing to accept a Chin with special medical needs? Are you willing to accept a Chin with a history of neglect or abuse who will need extra special love and attention? Are you willing to accept a Chin with behaviour problems who might require special training?
 
Are you willing to contend with seemingly endless shedding, a Chin’s ‘cat like’ nature ( a polite way of describing their willfulness), some possible difficulty in potty training? Will this work in your home?
 
Do you understand that it is in a Chin’s nature to remain somewhat aloof, although most Chin are incredibly loving and affectionate? Do you understand that Chin are not usually willing to do tricks or play fetch when asked? Will this work in your home?
 

Do you understand that rescue animals, in particular, may have issues that others may not- insecurities, quirks and so on, and are you willing to work with your Chin to ensure him or her and yourself the best home life possible? 
Please tell us how many hours per day on average your Chin would be without human companionship. 
Where will your Chin spend the hours you are away from home? (loose indoors, in a crate or ex-pen, a particular room, etc.) 
Where will your Chin sleep at night? 
Who will have primary responsibility for your Chin? 
If you are faced with an emergency situation, who will care for your Chin?
 
If you travel and cannot take your Chin, what plans will you make for it’s safekeeping?
 

Part Three: History of Pet Ownership

What animals currently live in your home? (please list age, type, sex and how long they have been part of your family)  Are they kept in or outdoors? 
Are they neutered or spayed? If not, why not?  If so, please provide vet's name who can verify. Please list any animals you have owned in the past who are no longer with you, and describe what became of them. 
Of all the dogs you have owned, what do you enjoy most about dog ownership? What do you like least about it?   

Part Four: References
JCCARE requires references from adoptive families. These can include family members not living with you, friends, etc. We ask for two personal plus one from your vet, if you have one. Please enter all the reference (verifiable) contact information here but we do need the Vet’s reference on office letterhead in hardcopy. (A fax will work, also.) Please mail the vet reference to: 
JCCARE,  Dana Baldinger,  1414 Harrington Ave SE,  Renton, WA 98058

Personal Reference #1: Please enter the name, address and telephone number
  		Personal Reference #2: Please enter the name, address and telephone number
 
Veterinarian Reference #1: Please enter the Veterinarian's name, business name, address and telephone number 

Is there anything else you would like to tell us about yourself? Any final comments?

Japanese Chin Care and Rescue Effort is a national not for profit organization dedicated to the health and welfare of our breed. JCCARE is run strictly from donations received from the public.  No person is paid for his or her efforts expended on behalf of JCCARE.

Japanese Chin Care and Rescue Effort requires that an adoption fee be paid for all Chin placed. Your Chin will arrive spayed or neutered and up to date on shots. Any health needs of the Chin will be discussed with adopters before plans are made.

By typing your signature you attest that all information submitted in this application is true:  


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