Car-Mir-Jac Yorkies
Yorkie Puppies for Sale
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Puppy Application

 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__________________
    ____________________________________________________________________
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?
      _________________________________________________________________________
     __________________________________________________________________________
     __________________________________________________________________________
16.  Have you ever donated money to the HSUS, PETA, ASPCA, or other national animal      welfare organization?  _________

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  mail to:

                                                            Cheryl Ann Nims
                                                           190 SE 45th Road
                                                           Lamar, MO  64759
                                                            
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