Adoption Application

Tibetan Spaniel Rescue Prospective Adopter Questionnaire

The Prospective Adopter Questionnaire is the adoption application form for TSCA Rescue. You may submit the form when you are first added to the prospective adopter database (the "waiting list"), and we will keep it on file. Or, you may submit it later when you see a Tibbie that you want to adopt. Submitting it in advance can speed up the process when you want to adopt a Tibbie in our care.

TSCA Rescue selects the forever home that’s the best match for each Tibbie in terms of family and lifestyle. In addition to reviewing your answers on the Questionnaire, the screening process involves reference checks and a home visit. For more information about the adoption process, see our Adoption page.

Please give some thought to each question as you answer. If you need to stop before completing the Questionnaire, scroll to the end where you will find a Save and Continue button. When you press the Save and Continue button, you will receive a link so that you can return to your Questionnaire later. You can also opt to have the link sent to you by email.

When you have finished answering all the questions, press the Submit button to send the form to us. If you missed a required question(s), you'll receive an error message. Scroll down through the form to find the errors in red. After correcting the errors, you must re-submit the form. If you made no errors, you'll see a confirmation message.

If you need help, you can reach us at info@tstrust.org.

General Information

Your Name(s):(Required)

Are you interested in a specific Tibetan Spaniel that is currently available for adoption from TSCA Rescue?(Required)

We notify people on our prospective adopter waiting list about available Tibbies via "Rescue Alert" emails. If you aren't already signed up when you submit this Questionnaire, we will add you to the waiting list and send you a "welcome email."

Yes

Not at this time. Please keep my application on file.

Tibbie's Name(s):(Required)

Are you at least 18 years old?(Required)

Yes

Email:(Required)

Cell Phone:

Other Phone:

Residence Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you have another residence?(Required)

Yes

Additional Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Profession:

Please list the names and ages of all persons who live in your home, including yourself:(Required)

Will children under 12 visit your home?(Required)

Dogs and small children should be supervised. Can you provide supervision at all times?

Yes

Do you or any family members have ongoing medical conditions or limitations (such as allergies) that may interfere with owning a dog?(Required)

Yes

Please explain the condition:(Required)

Your Pet Ownership

Do you currently own any dogs?(Required)

Yes

How many?(Required)

Please enter a number from 1 to 20.

Current age(s):(Required)

Age(s) when acquired:

Breed(s):(Required)

Gender(s):(Required)

Are all the dogs you own spayed or neutered?(Required)

Yes

Tell us about their temperament:(Required)

For example, are they active or couch potatoes, quiet or barky, independent or obedient, timid or friendly?

Have any of the dogs ever injured another dog or a person?(Required)

Yes

Please describe what happened.(Required)

Have you previously owned any pets?(Required)

Yes

How many and what kind of pets?(Required)

What happened to these pets?(Required)

Do you have other pets?(Required)

Yes

Tell us about each one:(Required)

Please include type of pet, age, gender, when acquired, and temperament.

Veterinary Information

This is about the veterinarian or practice that cares for (or will care for) your pets.

Veterinary Clinic Name:(Required)

We will contact your veterinary practice for a reference check.

Veterinarian:

Veterinary Practice Address:

Street Address City State / Province / Region ZIP / Postal Code

Veterinarian Phone:(Required)

Your Home

I live in a(n):(Required)

Do you own or rent your home (check one)?(Required)

Are you allowed to have pets?(Required)

Yes

Landlord Name:

Describe your home:(Required)

Do you have a safe and securely fenced yard with no holes or gaps in the fencing?(Required)

Yes

How do you plan for the dog to relieve itself?

How and when will the dog exercise?(Required)

How many hours a day are you away from home on average?(Required)

Where will the dog be when you are away from home?(Required)

Please be specific.

When you are away from home on vacation or extended periods, how will the dog be cared for?(Required)

Where will the dog sleep?(Required)

Are you willing to accept a dog that is not reliably house-trained?(Required)

Yes

Coming to a new home sometimes disrupts house-training for a transition period. How would you deal with a break in training?(Required)

Rescue dogs have often gone through bad experiences in their lives. When you first bring home a foster or adopted dog, the dog's stress and insecurity sometimes leads to less-than-perfect behavior, such as growling at other pets. The dog may need help to adjust to his new life. How do you feel about working with an experienced dog behaviorist or a force-free trainer who can help the dog adjust?(Required)

Will you make sure that the dog receives the following routine care, even if you can't do it yourself: regular brushing and mat removal, occasional bathing, nail trimming, ear cleaning, teeth cleaning?(Required)

Yes

Experience and Preferences

Why do you want to adopt a dog at this time? How do your family members feel about it?(Required)

Have you had any experience with adopting a rescue?(Required)

Yes

Please tell us about your experience:(Required)

Gender Preferred:(Required)

Age (in years) Preferred:(Required)

Do you understand that it isn't always possible to tell the age of a rescue?(Required)

Yes

Why do you think a Tibetan Spaniel is a good fit for your personality and lifestyle?(Required)

Are you willing to accept a dog that has treatable medical conditions such as those that require ear or eye drops, medicine or other treatments?(Required)

Yes

Maybe

If maybe, please explain:(Required)

Additional comments about your preferences:

Adoption Process

Do you understand that filing this form does not guarantee that you will be selected to adopt a Tibbie?(Required)

We select the home that is the best match for each individual Tibbie in terms of the Tibbie's needs and the family's lifestyle.

Yes

Do you understand that a visit to your home is a required step in the adoption process?(Required)

Home visits may be conducted in person or by computer.

Yes

First Personal Reference Name:(Required)

We ask for two personal references.

First Personal Reference Relationship:(Required)

Only one personal reference may be a relative.

First Personal Reference Address:

Street Address City State / Province / Region ZIP / Postal Code

First Personal Reference Phone:(Required)

First Personal Reference Email:

Second Personal Reference Name:(Required)

Second Personal Reference Relationship:(Required)

Only one personal reference may be a relative.

Second Personal Reference Address:

Street Address City State / Province / Region ZIP / Postal Code

Second Personal Reference Phone:(Required)

Second Personal Reference Email:

Do you understand that, if selected to adopt a Tibbie, you will be required to sign a contractual Adoption Agreement?(Required)

The Agreement requires you to certify that you will take appropriate care of the Tibbie and that, if you are unable to keep the Tibbie for any reason or at any time, TSCA Rescue will re-home the Tibbie. Our commitment is for the life of the Tibbie.

Yes

Do you understand that, if selected to adopt a Tibbie, a donation to the TSCA Rescue & Health Trust, a 501c3 non-profit, will be required to help defray the costs of rescue?(Required)

Donation amounts are based on age and any special needs of the dog. A typical donation is $250.

Yes

Do you understand that you may be responsible for transport-related costs?(Required)

This may include, for example, a travel crate, cost of a medical certificate, fares or fees required by airlines or other modes of transport.

Yes

Certain risks are inherent in handling dogs, and you must be willing to accept those risks. Do you agree that you will hold neither the Tibetan Spaniel Club of America, Inc. or its officers nor the TSCA Rescue & Health Trust or its trustees responsible for any loss, damage, injury, harm, claims, liability, costs and/or expenses of any nature whatsoever arising out of or in connection with adopting a rescue Tibetan Spaniel? Do you agree to this waiver of liability?(Required)

I agree to this waiver of liability.

Your Signature:(Required)

Enter (key) your name(s).

Signature Date:(Required)

Enter date you're submitting this form.

Tibetan Spaniel Rescue Prospective Adopter Questionnaire

General Information

Your Pet Ownership

Veterinary Information

Your Home

Experience and Preferences

Adoption Process

Thank you for your interest in adopting a rescue Tibbie.