Wisconsin Shih Tzu Rescue Adoption Application

This questionnaire is intended to be a guide to help you think about all the ways a Shih Tzu will impact your life and also determine if a Shih Tzu is the right breed for you. All of the questions concern various aspects of dog ownership that should be given serious consideration before deciding to share your life with any dog.

Me and my Family

If you were referred by a rescue member, please enter member name:
Name:     E-mail:
Address:  Home Phone: 
City:     State:  Work Phone:  
Zip:      Best Time to call: 
Please Note: We must know your state to process the application 
and you must be 21 years old to complete an application.

Number in household?  Children?  If Yes, what age? 


Please check any preferences on sex. Please note:The average age of a rescue is between 2 - 7 years of age and all rescues will be spayed/neutered before adoption. Shih Tzu frequenty live 16 - 18 years. If you prefer a younger Shih Tzu, your wait may be slightly longer. We rarely have puppies.


If you are interested in a particular dog, please tell us the dogs name and which petfinder site you saw it on.

Are you willing to accept a dog with special medical needs?

Are you willing to accept a dog with a history of neglect/abuse who needs extra love and attention?

Are you willing to accept a dog with behavior problems who requires special training?

Would you consider a Shih Tzu mix?

How long are you willing to wait for a Shih Tzu?

Why A Shih Tzu

Have you previously owned a Shih Tzu?

Have you read "Things You Need To Know Before You Adopt"?:

What do you like about the breed?

What other breeds have you considered?

Please describe what you feel are the characteristics of the ideal Shih Tzu for you and your family.

The Shih Tzu is a high maintenance dog, and while you may love the breed you may discover that you do not have the time or the resources to devote to its upkeep. But if you do, the Shih Tzu will more than repay you with a lifetime of loyalty

Are you prepared to pay someone up to $40, or more, every 4 weeks to groom your Shih Tzu? Or are you prepared to purchase a grooming table, clippers, scissors and other accessories and devote the time to learn to groom your Shih Tzu yourself?

Are you willing to spend approximately one hour each week brushing and combing out your Shih Tzu? This additional maintenance is required whether the dog is being professionally groomed or you are grooming your dog yourself.

Are you willing to pluck the hair from the inside of the ears monthly to prevent infections and to clean the eyes of accumulated matter daily if necessary? and Are you willing to clean the eyes of accumulated matter daily if necessary?

Are you prepared to deal with the cost of both routine veterinarian care (worming, annual shots) and non-routine/emergency veterinary care, especially as the dog gets older?

Your Home

Which of the these best describes your current residence?

Does your lease or home owners assoc. restrict pet ownership?

Does your town or city have restrictions on the number of dogs you can have?

Is your yard, or a portion of your yard, securely fenced?

If you have a pool, is it fenced?

If you have a dog run, is it secure?

If you do not have access to a fenced area, please explain how you plan to exercise your Shih Tzu and allow it to relieve itself?


Please provide three names as references, including your veterinarian and groomer. You must include your landlord (if you rent your home) as a 4th reference. Other references could include a neighbor or anyone who owns a Shih Tzu, other toy breed or other high maintenance breed; such as a friend, relative or co-worker who has knowledge of you with your dogs past or present. All 3 references may not be relatives. Your application will NOT be considered if you do not complete this section.

Name, Phone number, best time to call and relationship to applicant:

Care and Responsibility

Approximately how many hours a day will your new Shih Tzu be alone?

How long will the Shih Tzu be left outside?

Where will your Shih Tzu be when left alone?

Where will your Shih Tzu sleep at night?

Who will have primary responsibility for the care of your Shih Tzu?

Do you travel frequently? If yes, who will take care of your Shih Tzu when you are away?

Have you asked yourself whether your lifestyle is so busy you might not have the time or energy to properly care for a Shih Tzu?

Are you willing to take your Shih Tzu, and restrict your choice of housing to places where pets are allowed?

Does everyone in the family want a Shih Tzu?

Does anyone in the household have any known allergies to animals?

What is your definition of disciplining a Shih Tzu?

What will you do if your spouse, children or pets can't get along with the Shih Tzu?

History of Pet Ownership

What animals currently live in the household? (Please list type of animal, sex, age and how long you have owned them, and are they inside or outside animals)

Please list any dog you have owned in the past, name, breed, how long owned, explain what happened to it, including the age it died or left you.

All of the information I have provided is true and complete to the best of my knowledge.
Should a Shih Tzu be placed with me it will reside in my home as a pet. I agree to provide the dog with adequate food, water, shelter, affection and medical care.

Signature of Applicant:

Date of Application:

How would you like us to contact you?

Send E-mail (We recommend this method)
Please call (If there is no member in your local area and you select this method you may be called collect)

Thank you for taking the time to complete this questionnaire. Your answers will permit us to more effectively match available dogs' needs with your lifestyle and requirements.

Our E-mail address:rescue@usshihtzurescue.com


Please hit the send button only once.

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