Bluegrass Working Terrier Association Rescue
Adoption
Application (Please type or print)
Name: _____________________________________Date:____________________
Address:
___________________________________________________________
City/State:
_______________________________________Zip: _______________
Home Phone:
______________________Work Phone: ______________________
Email Address
(if you have one): ________________________________________
Best time
to call? ____________________________________________________
Do you
own / rent your home? __________________________________________
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/ Other (Describe)___________________
____________________________________________________________________
How
long have you lived at this address? ___________________________________
Do
you have a completely fenced yard suitable for a dog? Yes / No
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 terrier'exercise and toilet
needs?
____________________________________________________________________
Do
you have a suitable dog crate? Yes No
How many adults in the household?
_______ Children/Ages? _________________
____________________________________________________________________
How
many hours a day must terrier be alone? _________________________
Please
describe your lifestyle: Active / Passive
____________________________________________________________________
Do
you own other dogs or cats? Yes / No Spayed / neutered? Yes / No
Please
list breed, size, and gender of each: _______________________________________
___________________________________________________________________
Should
you find you must give this dog up, what would you do?_________________________________________________________________
____________________________________________________________________
Do
you have a regular veterinarian? Yes / No
Name: _______________________________________________________________
Address:
_____________________________________________________________
Phone
Number: ___________________________________
Do you want to adopt a
Male / Female / No Preference / Age Preference __________
Would you
be willing to consider a suitable dog of a different sex / age? Yes
/ No
Personal Reference
Name: ________________________________________Relationship
____________________
Phone: ___________________________
Thank you!
Send
completed application to:
Libba Hughes
75 Old Clifton Road
Versailles,
KY 40383
(859)873-8531 home
(859)873-1228 fax
libba@windstream.net
