Reference Form

Your relative, friend, neighbor or co-worker has applied to adopt a little dog from our organization, Lend a Helping Paw Shih Tzu Rescue. 

As part of the approval process, we engage in a dialogue with family and friends who can give us an insight into how we might expect the applicant’s new dog to be treated within the family. 

Please complete the following questions. Answering the questions typically takes about 10-15 minutes. We cannot adopt a dog to your friend or family member without this information. Your help is greatly appreciated. Thank you!

Lend A Helping Paw Shih Tzu Rescue Reference Form

Personal references

- Step 1 of 2

Applicant's Name *

First

Last

Reference Name *

First

Last

Reference Email *

Email

Confirm Email

Reference Phone *

How long have you known the applicant? *

How do you know the applicant? Select all that apply. *

• Family
• Friend
• Neighbor
• Co-worker

Next

Do you regularly visit the applicant's home? *

• Yes
• No

Does the applicant own or rent their home? *

• Own
• Rent
• Other

Describe the applicant's street. *

• Busy
• Quiet

Describe the applicant's neighborhood. *

• Rural
• Suburban
• Urban

Describe the interior of their home. *

Does the applicant have a yard? *

• Yes
• No

Describe the yard (condition, height and type of fence if any) *

Does the applicant have current pets? *

• Yes
• No

Please describe an interaction you have seen between the applicant and other people's dogs. *

Please list name(s), breed, age, and whether male/female and neutered/spayed, to the best of your knowledge. *

How are the pets treated at the applicant's home? Are they well cared for? Are they groomed? Do they have free run of the house? Are they allowed on furniture? *

Where are the pets housed? Select all that apply. *

• Inside (excludes garage)
• Garage
• Yard - loose
• Yard - tied
• Outside run
• Kennel
• Other

Does the applicant travel a lot? *

• Yes
• No

Who takes care of their pets when they are out of town? *

Does the applicant have children? *

• Yes
• No

How do the applicant's children treat their current pets? *

Tell us about visitors to the applicant's home. Are you aware of any children, grandchildren or step-children who visit? How do these visiting people and children interact with the pets? *

Has the applicant had dog(s) in the past? *

• Yes
• No

Please list name(s), breed, age, and whether male/female and neutered/spayed, to the best of your knowledge. *

What happened to these dogs (death, ran away, stolen, re-homed, surrendered to a shelter or rescue etc.)? *

To your knowledge, has the applicant ever had any pets hit by a car, or with a serious disease or injury? What were the circumstances and how did the applicant handle the veterinary care? *

To the best of your knowledge, are all family members in agreement about getting a new dog? *

What is the applicant's experience with puppies? *

What is the applicant's experience with aging pets as an adult? *

To your knowledge, do any of the applicant's immediate neighbors dislike pets? *

What is your honest opinion of the applicant as a pet owner? *

Would you be comfortable leaving your pet in the care of the applicant? *

Do you have any particular reservations or general comments you would like to add about the applicant? *

Signature *

Date *

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