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Application to Adopt

Please copy and paste the below form and then send in an email to



Street Address:

City and State:

How did you hear about Daisypatch Shih Tzu?

Do you have or have you had a Shih Tzu?

Why have you chosen this breed?  

Do you have a preference for male or female and why?

Do you have a preference for color or size?

Tell me about your family members (who live with you and who might often visit.

Do you have other pets  If so, tell me about them.

If you have other dogs, are they spayed or neutered?

Where will puppy be kept and who will be caring for the puppy?

Do you work outside the home and, if so, how will you care for the puppy?


Do you have a fenced in yard (not required)?

How many dogs/cats have you owned in the past 5 years?

Have you ever surrendered a pet back to the breeder, animal shelter, rescue,

or given away to an individual?

Are you aware of the grooming and vet care requirements for this breed?  Are you

able to pay for routine care as well as for any emergency that may arise?

Do you have a plan for someone to care for the puppy/dog, if at any time you are unable to care

for him/her?

Please read Contract (below) in entirety and be sure you are in agreement before you send in application to adopt.

Health Guarantee and Contract

Date: ________________

I agree to purchase this (male/female) Shih Tzu puppy with AKC registration # __________________________   


Chip# ____________________________

Sire: _____________________________     


Dam: ____________________________

Color: _______________________   


Date whelped: ____________________

Price: $ ________________

Non-refundable deposit amount: $ ____________________ 


Received on: ________________

Remaining balance: $ _____________________________ 


Received on: ________________

Your puppy is guaranteed to be healthy at time of purchase.  For this guarantee to be valid, you must have your puppy examined by a licensed veterinarian of your choice within three (3) days of the date of purchase. During the initial exam, should your veterinarian find a medical problem, you must contact me at the time of vet check.  If a medical condition exists not common to the brachycephalic breed and is said to be a life-threatening condition, a replacement puppy (or full refund of purchase price) will be given upon returning puppy within 72 hours.  If the puppy is out of state, the puppy must be returned within seven (7)

days.  Buyer is responsible for all shipping expenses.  A puppy must be returned with the AKC papers and a statement from the veterinarian certifying the diagnosis, including the date.  The breeder has one (1) year to provide replacement puppy of equal value and the same gender from the next litter available.  Replacement warranty will be terminated if the puppy was abused, neglected, or does not have up to date records of vaccinations and fecal records.  If a problem exists and the buyer does not return the puppy, he/she will be responsible for all vet bills incurred.  Breeder will not be responsible for any of the veterinary fees charged for the initial examination or for any other veterinary services rendered on that first visit.

The puppy is guaranteed for any/all life-threatening hereditary conditions for the first five (5) years.  This does not include conditions such as worms, umbilical hernias or stenotic nares.  Coccidiosis can manifest itself in a stressed puppy and treatment for this condition is not covered by this guarantee.  If a major life-threatening condition does occur, the puppy will be replaced.  Breeder has up to one (1) year to replace puppy.  If the puppy is not returned, all vet bills and expenses will be the buyer's responsibility.

If sudden death should occur, a necropsy must be performed and report verified by my veterinarian to verify the cause of death.  If death occurred from a congenital problem, a replacement puppy of the same sex and equal value will be given.  Breeder has one(1) year to replace puppy.

Your puppy will have had its first puppy shot at 8 weeks.  The vaccination series needs to be repeated every 3-4 weeks for a total of three to four puppy shots.  It is your responsibility to make sure the puppy is vaccinated at those ages.  If your puppy is exposed to parvo and/or distemper before the full vaccine series

is completed, he/she can be susceptible to these viruses.  It is recommended you do not take your puppy to places he/she might come in contact with these viruses (such as pet stores, dog parks, etc.) or allow strangers to pet or come in contact with your puppy until he/she has had a full series of puppy shots.  I will not be responsible for a puppy's health if he/she is given a vaccine with Lepto or re-vaccinated before the 3 week interval.  He/she will also need a rabies shot at the age determined by your veterinarian.  Your puppy will possibly need booster shots and current rabies.  This will be determined by your vet.

If the Seller determines that the Buyer is not suited for a Shih Tzu puppy for any reason, the Seller has the right to cancel the sale before delivery of the puppy.  The Buyer's deposit will be refunded upon cancellation.

Buyer also agrees and understands that the size and color is only an estimated idea depending on previous repeat litter or size of parents.  There is no guarantee as to how big or small or what color the puppy will be at adult, full grown age.

Spaying/neutering of this puppy is recommended.

If for any reason, at any time, Buyer is not able to care for or cannot keep this puppy/dog, Buyer must give Seller first option to take puppy/dog back.  This is to ensure that the puppy will not be passed from one family to another without my knowledge or does not end up in an unwanted situation, shelter, or rescue.  No dog deserves to be dumped in a shelter or feel unwanted.

All puppies are sold with limited registration unless prior arrangements for full registration have been made. Limited registration means that the dog is not to be used for breeding.  Limited registration means the dog will be ineligible to be entered in a breed competition in a licensed or member dog show.

This contract is non-transferable and void if a puppy changes ownership from Buyer stated above.  Failure of the Buyer to comply with any condition of the Agreement will relieve the Seller of any obligation to the Buyer.

I have read this contract, understand fully, and will abide completely in order to keep this guarantee in full effect.

Name: _________________________________

Address: _________________________________

City: __________________


State: ________________ Zip: ________

Phone: _________________________

Email: _________________________________

Signature of Buyer: _________________________________  Date:  _____________

Signature of Seller: _____________________________________  Date: _____________

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