Irish Setter Club of Central Connecticut

Rescue Adoption Application
 
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Date:
Name:             Phone:
Address: Street             Email:
               City   
               State  Zip
Occupation:
Household members & ages:
                                                 
Other pets & ages:
Veterinarian's name:Phone:

Home: own renttype house apartment condoneighborhood city suburb rural
If renting, landlord's namePhone
Fenced yard: yes noheightsizetype fence
Dog will live  inside outside
Is an adult family member home during the day?  yes no
If not, hours dog will be alone

Have you owned an Irish Setter before? yes no
If yes, please give details (breeder, what happened to it)
     
Have you ever crate-trained a dog? yes noTaken an obedience course? yes no

Preference: male female no pref.age range under 2 years 2-7 years over 7 years no preference more specific
Would you consider a special needs dog, i.e. requiring medication, obedience training? yes no
Briefly tell us why you want an Irish Setter
     
Who referred you to us?

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.  The submission of this form is my agreement to the above statement.
Name of submitter: