Contact Info
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
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Lifestyle
Occupations
*
Members of household & their ages
*
Current pets, Breeds, & Ages
Is an adult family member at home during the day?
*
Yes
No
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Veterinarian Info
Veteranarian's Name
*
Veteranarian's Phone
*
-
Area Code
Phone Number
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Housing
Do you...
*
Own
Rent
Type of Housing
*
Apartment
Condo
House
Landlord's Name
*
Landlord's Phone
*
-
Area Code
Phone Number
Is your yard fenced?
*
Yes
No
Height of fence
*
*In Feet
Size of Yard
*
*In Square Feet
Where will the dog sleep at night?
*
If outside, describe shelter
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Previous Experience
Have you owned a dog before?
*
Yes
No
Please provide details (breed), how you acquired it, what happened to it.
Have you crate trained a dog?
*
Yes
No
Have you taken an obedience course with a dog?
*
Yes
No
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Preferences for Adoption
Gender
*
Male
Female
Either
Age Range
*
Ex. 3-5 Years
How did you hear about our Rescue Program?
*
By entering my initials here I certify that the above information is true and I understand that, prior to placement in my home, the above information maybe verified. I also agree to a personal interview with a member of the Irish Red and White Setter Association of America, if requested, to determine the suitability of my home and my ability to care for an Irish Red and White Setter. Any questions please feel free to contact Ciesla Tammy at Tammycedar@hotmail.com.
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