Temporary Shelter Request

Name*

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Tell us about why you are requesting temporary shelter?*

How long are you requesting temporary shelter?*

Name of Pug*

Age of Pug*

Spayed/Neutered?*

YesNoI don't know

Tell us about your pug. How does your pug sleep? What do they eat and what are their mealtime routines?*

Is your pug friendly with other dogs?*

YesNoI don't know

Has your pug ever bitten a human or attacked a dog or other animal?*

YesNoI don't know

Is your dog current with veterinarian care, including rabies and free of any communicable diseases?*

YesNoI don't know

Veterinarian records for my pug can be obtained from:

Veterinary Clinic Name & Phone Number

Emergency Contact*

First NameLast Name

Emergency Contact Phone Number*

Please enter a valid phone number.

While we'll love the pug as it's our own, in the event the worst happens, Church of Pug is not liable for injury, death, theft, damages caused to or by the pug/dog. This contract is limited to 30 days, as defined above, and must be revisited every 30 days not to exceed 90 days. In the event the owner cannot be reached and/or does not respond within 30 days of the last contract expiration, the owner surrenders the dog to Church of Pug for permanent placement.*

I accept and acknowledge these terms and conditions

Temporary Shelter Request

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