| |
Central Rockies Schipperke
Rescue Application
|
To print this page, use your
browser's print command. |
| |
Name: ______________________________
Spouse's Name: _______________________
Address: _____________________________
City: ___________ State: ____ Zip:
_____
Daytime Phone: (_____ ) ______________
Evening Phone: (_____ ) ______________
Occupation: ________________________
Spouse's Occupation: ________________
Ages of children at home: ______________
Does everyone in the
household want to adopt this dog? _____
Other animals in household: ____________
Dog breeds previously owned: __________
If gone, what happened? ___________
Do you live in a house or apartment? ___
If you rent, do you have your
landlord's permission? ______
Landlord's name: __________________
Landlord's phone number: ___________
Do you have a securely
fenced and gated yard? _______
Where will the schip spend:
the day? __________the nights? __________
How many hours will the schip be alone:
During each day? _________________
During each week? ________________
How many weekly visitors do
you have to your home? ____________
Do you understand that if the adoption does
not work out, you must return your Schipperke
back to our Rescue Program? _______
|
|
Preference: Male Female Age _______
If you have marked a preference, would you be willing
to consider a suitable dog of a different (circle) Age
Sex
Do you understand that CRSC Rescue requires all animals
to be spayed/neutered? _____
Do you agree to license this dog and give regular health
care? _______
Do you agree to contact CRSC if you can no longer keep
this dog? _______
Are you willing to allow a representative of CRSC to
visit your home by appointment? ______
Do you understand that the Central Rockies Schipperke
Club reserves the right to refuse an applicant? _______
Will you allow the CRSC to forward your application
to other regional and national Schipperke rescue efforts
for consideration? ________
All of the information I have
given above is true and complete. I understand that
should an animal become available for adoption, I
will be asked to sign a legal Contract regarding said
adoption. I will provide the animal with a secure
ID tag for identification purposes which will be worn
at all times. I will obey any and all animal control
regulations governing the area in which I live and
to license this dog according to such regulations
within one month of adoption. I agree not to sell,
trade, transfer ownership, abandon or dispose of this
dog in any way, but to notify CRSC if I must relinquish
custody of the dog. This includes release to family
members. I agree to allow a CRSC representative to
examine the dog and his or her living conditions and
to surrender this dog to said representative if the
conditions are found unsatisfactory. I agree to assume
full responsibility for this dog's actions and for
any damage that might be done by this dog. I agree
to keep this dog as my household pet and companion
and be sure dog is in a secured area when unattended.
The dog will not be allowed to roam free at any time.
I agree to never chain or tie this dog unattended.
In accordance with common sense, I agree never to
allow this dog to be transported in the open bed of
a pickup truck or similar vehicle.
Signature: _________________________
Date: _______________
|
| |
Mail to:
SCHIPPERKE RESCUE
Central Rockies Schipperke Club of Greater Denver
PO Box 370504
Denver, CO 80237-0504 |
|
|
|