Please complete our online Adoption Application. After Submission PLEASE Download and read our Adoption Contract as you will need to complete it upon final adoption. Thank You and if you have any questions please feel free to contact us.


Drivers License/Photo ID #:
Home Phone:
Cell Phone:
Work Phone:
Best Time to Call:
Date of Birth:
Do You Own or Rent::
How long have you lived in your current home?
What type of residence do you live in ie: Apt, single family home etc:

Who lives with you and anyone under 18 that visits one or more times a month:

Room mates:
Children w/ Ages:
Are there any Pet restrictions where you live such as: Rental Agreements, HOA's and City Rules?
Explain if Yes:

Is everyone in the household in agreement about this adoption?
Who will be the dog's primary care taker?
How many hours a day will the dog be home alone?

Where will you keep the dog when:  (Select all that apply)

You are away?:
You are at home?:
The dog sleeps?:
You are on vacation?:
Other details you want us to know:

Who will care for your pets in case of emergency?

Name, relationship and Phone #

Please describe your yard.

Fence Height:
Fence Type:
Approximate Sq Footage of yard:
If your yard/pool has no fence please explain how you plan to excercise and bathroom the dog:
Pet Details
Have you ever or do you now own a Xoloitzcuintli?:
Are you applying for a specific dog already in the XPBR program? If so which one and why?:
Do you want a:
Do you want:
Do You want :
Do You Want?
Do You Want:
OTHER Desirable Attributes :
What brand/type of dog food will you be feeding your Xolo?
What do you feel is a realistic budget for this animals care on a monthly basis?
What attracted you to adopting a Xoloitzcuintli Dog?
Please list your Current and Past Pets (last 5 years)
1) Name/Age
Select all that apply:
Still with you?
2) Name/Age
Select all that apply:.
Still with you?..
3) Name/Age-
Select all that apply::
Still with you?.
If you have more than 3 pets please list them here with the same info as above:
Describe the basic temperament and characteristics of all current dogs in your care.
Veterinarian Name/Address :
Vet Phone #
Name used on account at Vet's office if different than on application:
Employer or Professional Reference Phone Number and Email Address:
Personal Reference Name, Phone Number and Email address:
Any other Comments or Info you would like to share with us:
Are you aware of our adoption fees?
Have you downloaded and read our adoption Contract?
Do you understand that we require a home inspection?
What problems might make you consider returning this dog?
Other reasons:
If a behavior problem arises at a later date, are you comitted to working with the dog to correct it?

XPBR Members will be available to help you at all times and especially during the transitional time. 


I have completed this application to adopt a Xoloitzcuintli from Xoloitcuintli Primitive Breed Rescue (XPBR)as accurately and completely as possible. I understand a Member of XPBR will contact me within 3 weeks of receipt of this application to initiate processing, and that there may not currently be a compatible dog available for my adoption. If I have indicated that other rescue referral is acceptable , I understand that a copy of this application may be forwarded to that agency, and that I will have to qualify for an adoption through hat agency's process and pay their required adoption fees.  I have reviewed the XPBR Adoption Contract and understand all legal applications of adopting a Xoloitzcuintli from XPBR. I understand that this application does not commit me to adoption and that I may withdraw this application at any time prior to adoption with written notice. I also understand the compatibility requirements of placing a Xoloitzcuintli in the right home and will accept XPBR's decision regarding the placement of any specific dog I may have interest in. I understand acceptance to adopt is based on any of the following: Reference Check, Home check, Vet check, experience with/knowledge of the Xoloitcuintli breed, any derogatory information which would place the adoption at risk. I also understand that application denial may or may not receive explanation at the discretion of the XPBR Board of Directors.

Signature (please type Name in acceptance of above terms:

XPBR has $15.00 Application Fee that is applied towards your adoption fee once approved as an adopter. If you are not re-directed automatically, please go to the Home page and click on the Donate Button to make your payment. Please note the name of the dog you are applying for or just the name on your application if no specific dog is being applied for. 

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