SBRKY
Adoption Application
Please be sure to answer all questions. If you feel that it does not apply to you, please put N/A
Name of the dog you are interested in adopting.
Your name: First, MI, Last
Your spouses name First, MI, Last:
Your email address:
Your home address:
and mailing address
if different from home address.
Your home Phone number
Your work Phone number
How did you learn about SBRKY? Online site,
friend, Petfinder, surfing the web
A successful adoption depends upon both the selection of the right dog for the right household and the
understanding of his/her care-taking needs. So that we may better assist you in this selection, please answer
the following questions as completely as possible.  Thank you.
Please tell us why you want to adopt this dog.
How many people in your household?
 What are the ages of any minor
children are there in your home?
Approximately how many
hours in a 24 hour day will
the dog be left alone?

Are you established with a vet?
Please provide your vet's full name, complete
address and phone and Fax  numbers.
Have you ever owned a dog before?
 Have you ever owned a Yorkie before?
If yes, please tell us what happened
to the dog or any other dog you have
owned.
Do you currently have any other pets (cats, birds
etc) in your household? IF yes, please list
Do you currently own or rent your home?
Important:  If you rent, we must have proof of your legal ability to keep a dog (i.e., a copy of your lease,written
letter from your landlord, tenants association or rental office with phone number,) available for inspection when
your home visit is performed.
What most closely describes your home? House, apartment, town
house, condo, mobile home, or farm...
Do you have a fenced area or
yard for your dog? Yes or No
If yes, what type of
fence?
Are you willing to reinforce or
repair your fence is needed?
Yes or NO
If NO, how do you plan
to exercise your pet?
Do you have neighbors who
would be bothered by a barking
dog? Yes or No
Have you ever taken a dog
obedience course? Yes or No
Have you ever adopted a dog?
Yes or No. If yes, from whom?
Please give full name of place.
Are you willing to take your dog to a vet for a physical examination within 10 days of adoption? Yes or No
If necessary are you wiling to:  (answer Yes or No for each)
House train your dog
Take your dog to obedience school.
Purchase a crate and crate train your dog.
Do you understand that your dog will need: (answer Yes or No for each)
Need to be checked Annually  for Heartworm and be placed on Heartworm preventive
Require routine and emergency veterinary care including dentals  
Need periodic grooming to include brushing coat, trimming nails and ear cleaning.
Need plenty of exercise on a daily basis
Are you aware that:  (answer Yes or No for each)
Young puppies (under 6 months) are rare and popular in rescue. If
you want a puppy are you willing to be placed on a waiting list?
These small dogs are companion dogs and they are to live inside
your home and be an active part of your family
A small dog should never be off the leash.
The average cost in the first year to "outfit" your dog (leash, collar,
bowls, food, vet care etc.) could exceed $1000.
Do you know that before you can adopt from SBRKY: (answer Yes or No for each)
A volunteer will visit your home and meet with your entire family.
You will pay an adoption fee and be required to sign a legal
adoption contract.
If the dog you are interested in is not available, would you be interested in another?
If Yes, what is the name of the second dog you would like to join your family?
Under what circumstances would you give up your dog? Please explain fully in the
space provided below. Please be specific...biting, move, too much vet care etc
We ask these questions so that you will think about all of the aspects of bringing a dog into your family. Your
response does not automatically cause you to be disqualified for adoption .
Do you have a long time friend or family member who would be willing to provide long term
care for the dog in the event an emergency should arise? Yes or No
Please use this space to provide any
additional information you feel is pertinent:
All of the information I have provided in this application is, to the best of my knowledge, true and complete. I understand
that falsifying information on this application, or any other forms during the adoption process, disqualifies me from
adoption. I am aware that submitting my application does not guarantee that I will receive approval to adopt a dog from
SBRKY and that SBRKY can reject any applicant at any time during the adoption process. I also understand that the
$10 application fee is non-refundable.

With the electronic submission of this application I am authorizing SBRKY to contact my veterinarian to discuss my
veterinary records.
Applicant's Signature
 Date:
Co-Applicant's Signature
 Date:
Thank you for your interest in making a SBRKY dog a member of your family.