A Program of the Central Pennsylvania Animal Alliance
	Application to Adopt Merrick Pet's Name:  Personal Information       Is there a specific dog or dogs that you may interest you? If so please specify their names           Age:   Applicant's Name:   City, State and Zip   Street Address     Email Address       Evening   Phone Number  Daytime     Preferred Phone to call and best time to contact you?         Your Employer Name, Occupation and Phone Number             Home Information         Spouse or Partner's Name         Spouse or Partner's Age     Employer and Phone Number         Do you own or rent your home. Renters we will ask for a copy of your lease. If no lease, we will need to speak with your landlord.             Please describe the area you live in.         Select Urban Suburban Rural   Type of Area         Please list name, ages and relationships of all members of your household that may be there on a semi regular basis.             Do you have plans to move in the next year?           Even if you don't have plans at this time for moving in the future what considerations would you make regarding your dog(s) and any other pet's should you find yourself needing to move from where you now live?                 Do you have a fenced yard? If Yes, please select your fence type.       Select Yes No   Select Chain Link Privacy Invisible         If you don't have a fence, kennel or run how will exercising/toileting be handled?               Pets           Pets you currently own and their ages or have owned    (Please elaborate on the ones you no longer have.)           How many years have you owned dogs and what do you know about canine behavior?           Select Yes No Are your pets spayed or neutered?   Select Yes No Have you ever adopted a rescue dog before?   Have you ever turned a pet into a shelter or rescue? If so, please indicate reasons why.             English Setter Breed and Care         What brought you to the English Setter Breed?         Do you prefer a male, female or no preference.       Select Male Female No Preference     Do You have a color preference?   Select Yes No       Select Blue (Black) Orange (Liver) Tri-Color (Black,Orange and White)     If you have more then one color preference, please indicate.         Do You have an age preference. If so what?   Select Active Normal Moderate Laid Back No Preference Activity Level Preference   Select Yes No Probably Would you consider a special needs English Setter?     Would you consider a Senior English Setter?     Select Yes No Possibly       Where will this English Setter sleep?         During a normal work or school week how many hours will this English Setter be home alone?         Where will this English Setter be kept when no one is home?             Who will be the primary caretaker for this English Setter?             Have you ever taken a dog to obedience classes?       Select Yes No Possibly           Do you plan on taking your English Setter to obedience classes?     Select Yes No Possibly       Do you own a dog crate or have experience using one?         If you plan on having children in the future what will you do with your English Setter?           What would make you return your adopted dog?               Veterinarian           Name, Address and Phone Number of Veterinarian.           How long have you been a client of this Veterinary Practice?         May we contact your Veterinarian? If No, Why?         References         List two references you have known for at least 3 years, Excluding Relatives and Veterinarian.       Reference #1:  Name, Address, Phone Number & Email Address           Reference #2: Name, Address, Phone Number & Email Address           Since we are looking for commitment in our adopters, how far are you willing to drive to pick up your English Setter (hours or miles)? Note we do not deliver our dogs to adopters.           Above & Beyond English Setter Group expects to interview every Potential Adopter, their references and conduct a home visit.  Do you agree to all?             Please tell us why you think you would be a good candidate to adopt an English Setter from Above and Beyond English Setter Rescue?                         My Family and I agree to accept these terms.  Please Initial.   Any dog adopted through Above and Beyond English Setter Rescue must be returned to A&B. They cannot be transferred, without A&B's permission, to another person or rescue.           I agree by Initialing this line that typing my name is the same as signing your name to this legal document.   I give permission to Above and Beyond English Setter Rescue and its Agents to type my name to this document, causing it to be the same as my legal signature on this document (Applicants Initials)             Financial and Physical Verification       I hereby certify that I am financially and physically able to care a Setter and for the bedding, toys, crate, and so on which can be costly and I am able to meet these requirements. I further testify that I am physically fit to provide all necessary activities with my dog. (Applicants Initials )               Permission to Investigate       By submitting this application to Above and Beyond English Setter Rescue I grant permission to investigate my answers and to contact anyone I have listed. (Applicants Initials )             Signature (Please Type your Full Name.)       Date     Above and Beyond reserves the right to refuse any applicant or potential adopter, at any time, whom we feel not be an appropriate home for an English Setter. Before submitting your application be certain it is fully completed. If not, this could delay our ability to review it in a timely manner.   Thank You. Please print this page for your records before submitting your application.
	Hounds of Prison Education A Program of the Central Pennsylvania Animal Alliance