Adopt ~
A ~ Setter
IRISH SETTER RESCUE APPLICATION
Name ________________________________________________________________
Address_______________________________________________________________
______________________________________________________________________
How long have you lived there?_________________________________________
Email address_________________________________________________________
With whom are you/spouse employed?____________________________________
Occupations?__________________________________________________________
How long have you worked there?_______________________________________
Phone (day) _________________ Phone (night) __________________________
Members of household and their ages: _________________________________
______________________________________________________________________
Other pets, their breeds, names and ages: ____________________________
______________________________________________________________________
Veterinarian's name and phone: _______________________________________
______________________________________________________________________
Do you own_____ rent _____ your house ____ apartment _____ condo _____
Do you have a pool? ______ In the ground or above?___________________
If in the ground is it separately fenced?_____________________________
Do you have a fenced yard? __________________________________________
If yes, height of fence _________ size of fenced in area______________
Type of fence?________________________________________________________
If you do not have a fence, how and where will the dog be exercised and
Be allowed to eliminate?_______________________________________________
Neighborhood type: city __________ suburb __________ rural __________
If you are renting, name and phone of landlord: ______________________
______________________________________________________________________
Where will the dog live during the day? ______________________________
At night? ____________________________________________________________
Is an adult family member home during the day? ______________________
If not, give hours dog will be left alone ___________________________
Have you owned a dog before? _____ If yes, please give details (breed,
where did you get it, what happened to it?) __________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Do you plan to change the name of your new dog?_______________________
Have you ever crate-trained a dog? ___________________________________
Have you ever taken an obedience course with a dog? _________________
Preferences for adoption: male __ female __ age range ________________
Would you consider a special needs dog, for example, one that requires
medication, one that needs obedience training? _______________________
What do you know about the Irish Setter breed?________________________
Who referred you to us?_______________________________________________
Who will be the primary care person for this dog?_____________________
What are your plans and goals for this dog?___________________________
Briefly tell us why you want an Irish Setter _________________________
______________________________________________________________________
______________________________________________________________________
I certify that the above information is true and I understand
that, prior to the placement of an Irish Setter in my home, the above
information may be verified. I also agree to a personal interview with a member
of the Irish Setter Rescue Program, if requested, to determine the suitability
of my home to care for an Irish Setter.
Signature ____________________________ Date ______________________
Please return to:
Deanna Cuchiaro
W-732-514-6014
Fax-732-514-6038
irishrescue1@aol.com
http://www.irishrescue.org
http://www.irishrescue.petfinder.org