Application Form MAKE A DONATION Name *Email *Phone *Address *Address Line 1CitySelect a stateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDo you own or rent?OwnRentLand lord's Name & PhoneDo you live in a ...HouseTown HouseApartmentHow long?Are pets allowed?YesNoIs your yard fenced?YesNoWill pet be kept ...InsideOutsideTiedVeterinarian's Name & PhoneDo you have other pets?YesNoPlease list breed, sex, age, number, species, and whether spayed or neuteredDo you have children?YesNoPlease give number & agesIs someone home all day?YesNoWorkFTPTRetiredHours of workReference 1: Name, Address, PhoneReference 2: Name, Address, PhoneShar-Pei Preferred SexMaleFemaleDoes not matterColorBlackRedFawnCreamChocolateSableApricotDoes not matterWhy do you want a Chinese Shar-Pei from the rescue?WebsiteSubmit
