Adoption Form
If you would like to adopt one of our dogs, please read the following information, fill out the adoption form and then click on the
SUBMIT button.
Anyone interested in adopting a dog through CSTMR must fill out the adoption form below.  This adoption form helps us to determine the best "fit" for
the dog and the potential new owners.  Potential permanent homes must also agree to a home check before an adoption can take place.

Each dog receives a veterinary check-up after he or she is received by CSTMR.  It is our policy to make sure that each dog is spayed or neutered,
current on vaccinations, tested for heart worms, and groomed.  The potential owner agrees to pay the adoption fee that is used to cover medical,
grooming, food, and any other expenses associated with our rescued dogs..  The adoption fee is $300.00.

CSTMR does its best to obtain as much information as possible about each dog.  However, we cannot guarantee the health or behavior of any dog
adopted through our group.

In a few days, if you have not received an acknowledgement that we have received your application, please contact the Director, Nancy Beims at
720-331-2877 and we will work with you to get your information.
Applicant Information
What are the names of the  available
dog(s) that you are interested in adopting?
Name:
Street Address:
City:
 State:
 Zip Code:
Home Phone (with Area Code):
 Work Phone (with Area Code):
E-mail Address:
Date of Birth:
 Occupation:
The Shih Tzu, Maltese, and Lhasa Apso Breeds and Preferences
Yes
The Shih Tzu, Maltese, and Lhasa Apso breeds are high maintenance dogs.  Are
you willing to spend 1 hour each week brushing and combing the dog(s)? (This will
be required even if you do use a groomer).
No
Picture yourself in 15 years.  Imagine what
your life style will be like.  Now, with that
picture in mind, consider that you will be
caring for an older, deaf, blind and possibly
incontinent dog.  Explain why you think you
can make the commitment to care for this
little dog with the same love and devotion
that he/she has given you for the last 15
years?
People that Live with You and Visit You Frequently
Names, Ages, and
Relationships to you
of People Who Live
with You or Visit You
Frequently:
Household Information
Please check all that apply:
Own
 Single-Family Dwelling
Fenced Yard
 Smokers in House
Rent
 Condo/Apt./Duplex
Doggie Door
How long have you lived at the
above address?
Yes
If renting, do you have your landlord’s
permission to keep dog(s)?
No
Name and Telephone
Number of Landlord:
Yes
If you do not have a securely fenced yard,
how will you exercise, confine, and provide
for your dog's need to eliminate?
If you have a yard, is it
securely fenced?
No
Yes
Yes
If you have a dog at this time, do you use an
electronic fence to keep it in your yard?
Does everyone in the family want a new dog?
No
No
Current Pets
Please provide the following information about each of the pets you currently have:

  • Name                                                            
  • Breed
  • Sex
  • Neutered/Spayed
  • Age when you got him/her
  • Where they are kept when you are gone (i.e., indoors, outdoors, both)
  • Are they up to date on vaccines?
  • What you feed your pets
  • Name and telephone number of current or previous veterinarian
Have you ever sold, given away and/or surrendered a pet(s) of yours?  If so, why?
References
Please give us two references who have dogs that we can contact for information about how you interact with animals. Please list people you know well that
can tell us why you would be a perfect owner.
Name:
 Name:
E-mail:
 E-mail:
Daytime Number:
 Daytime Number:
Evening Number:
 Evening Number:
Other Questions
Where will your dog be
when you are at home?
How many hours per day will
your dog be on its own?
Where will your dog sleep
at night?
Where will your dog stay
when no one is home?
May we visit your home to
verify the information you
have provided?
Are you willing to attend
obedience classes with your
new pet?
What will you do with your
dog(s) if you move?
Please give the name,
address and phone number
of your current groomer or a
groomer you used in the
past with your previous pets.
What circumstances, in
your mind, justify getting
rid of a dog?
Thank you for taking the time to complete this application. By submitting this application you attest to the truthfulness of your
answers.   Falsification of any of the above information will be grounds to disallow your adoption of a rescued dog.
I/we hereby swear that all of the information provided above is true and accurate to the best of my/our knowledge.  Should a dog be placed with me/us, it will
reside in my/our home as a pet.  I/we agree to provide the dog with adequate food, water, shelter, love and affection, training, identification, and medical care.  I
also understand and agree that the dog will never be given to a shelter, but if for some unforeseen reason I/we need to find a different home for the rescue dog,
I/we will contact the rescue organization and place the rescue dog with same, so that a suitable home may be found for him/ her.
ALL APPLICANTS MUST SIGN AND
DATE BELOW
Your typed name and date in the signature block constitutes electronic signature and submission of application.
Signature of Applicant:
Date:
Signature of Co-Applicant:
 Date:
Click on Submit
button to send form.
 Click on Clear button to
clear form and start over.
If you would like to donate to the
Rescue, please click on the
"Donate" button.  We will accept
any amount you would be willing
to give.  Thank you.