IRISH SETTER CLUB OF COLORADO

Irish Setter Rescue

Adoption Application (Please type or print)

Date: ______

Name: ______

Address: ______

City: ______State: ______Zip: ______

Home Phone: ______Work Phone: ______

Email Address (if you have one): ______

Best Time to Call: ______Occupation: ______

Do you own or rent your home? ___Own Rent

If you rent, do you have landlord's permission to keep a dog? ____Yes ____ No

Name of Landlord ______Phone No ______

Do you live in a House Apartment Trailer

How long have you lived at this address? ______

Do you have a completely fenced yard suitable for a dog? ______

Do you have a kennel run? Yes No

Describe fence or kennel run type, height and size: ______

If no fence or kennel, how will you handle a setters exercise and toilet needs?

______

Do you have a suitable dog crate? Yes No

How many adults in the household? ______Children? ______

Age and gender of children? ______

How many hours a day must the setter be alone? ______

Are there other visitors to your home, human or animal, with which a new dog will have to interact? ______

Please describe your lifestyle: Active Passive

Do you own other dogs? Yes No Spayed/neutered? Yes No

Please list breed, size, and gender of each: ______

Do you own cats? Yes No If yes, how many? ______

Any other animals? ___Yes No If yes, please describe: ______

How many dogs have you owned in the past five years? ______

If you do not still own the dog(s), please describe what happened to it (them). Please be specific.

______

Have you owned a Irish Setter before? ___Yes ___ No

Why did you choose this breed? ______

What activities do you plan with this dog? ____Pet____Guard____Hunting ____ Obedience____ Other

Do you have a regular veterinarian? ___ Yes ___No Name: ______

Address:______Phone Number: ______

Do you want to adopt a Male Female No Preference Age Preference ______

I would be willing to consider a suitable dog of a different sex ____ age

Personal Reference

Name: ______Relationship ______

Phone: ______

Thank you!

Send completed application to:

Susan Murphy

Irish Setter Club of Colorado Rescue

709 Road L

York, NE 68467

402-362-0276 - voice

303-819-7696 - cell

email: redscent.co@ att.net

or

Nancy King

26o Bobcat Drive

Milliken, CO 80543-9444

970-587-5366