Crest Care Printable Form
To send the application via email, click here
Please
mail to:
Crest-Care
192 Parkers
CREST-CARE, Inc
Representative Application
NOTE: (NO APPLICANT
WHO HAS OR PLANS TO USE AN ELECTRONIC FENCE, OR TIE OUTS WILL BE CONSIDERED.
FURTHER, NO APPLICANT OWNING AN INTACT ANIMAL WILL BE CONSIDERED. EXCEPTIONS
WOULD BE CERTIFICATION FROM A VETERINARIAN SAYING THE ANIMAL IS NOT HEALTHY
ENOUGH TO BE ALTERED, OR THE ANIMAL IS EITHER BEING SHOWN OR IS A FINISHED
CHAMPION UNDER THE AGE OF SEVEN (written proof to this effect is required).
Failure to complete required questions will result in application not being processed.
Name _____________________________________________________
Street Address _____________________________________________
City _____________________________________________
State/ZIP _____________________________________________
Home Phone: _____________________________________________
E-Mail address: _____________________________________________
Date of Birth: _____________________________________________ *must be at least 21 years of age to adopt
Please Note: Applicants that
pass the veterinarian and personal reference check will be requested to furnish
their drivers license number via phone or
Occupation _____________________________________________
Business Phone _____________________________________________
Marital Status _____________________________________________
If you have a significant other, does that person approve of your
involvement with our organization? Yes ______ No
Do you have children? _______________________
If yes, what are their ages? _____________________________________________
Do you have children visiting often? _____________________ If yes, what are their ages? __________
Personal Reference name and address (please use a reference other than immediate family) _____________________________________________
Personal Reference (name and phone) _____________________________________________
Vet reference (name and phone) _____________________________________________ * REQUIRED
Do you support spay and neuter contracts: _____________________________________________
Do you own Chinese Cresteds? ______ If yes, how many__________
Do you breed Chinese Cresteds? ____ If yes, how many litters per year? _______________
Do you breed any other breeds? _______________ If yes, how many litters per year ________________
Do you breed any other type of companion animal? __________________
If yes, what kind and how many per year? _____________________________________________
What is the TOTAL number of animals housed at your home? _______________________________
WILL ADOPTING A CREST-CARE DOG PUT YOU OVER THE LIMIT OF DOGS ALLOWED BY YOUR CITY OR TOWNSHIP? _______________________________
List species of animal, name, sex, and age for each animal permanently in your care.
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
List species of animal, name, sex, and age for each animal temporarily in your care.
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
Have you previously adopted a dog on an adoption contract? _____________________________________________
If yes, where is the dog now? _____________________________________________
Do you own your property? _____________________________________________
If you rent, what is your landlord's policy on animals? _____________________________________________
Landlord's name and phone number _____________________________________________ * REQUIRED
Does the community you live in have any restrictions on number of animals allowed? _____________________________________________
If yes, what is that policy? _____________________________________________
Does your residence have a fenced area?___________ If yes, what is the approximate size? ____________
Are you a member of any kennel or training club? _____________________________________________
If yes, what are the names of the clubs and what duties do you assume as a club member? _____________________________________________
Are you a member of or do you support any rescue or animal rights organizations? _____________________________________________
If yes, what organizations and in what way do you support them? _____________________________________________
Have you read Crest-Care, Inc.'s Policies and Procedures? _____________________________________________
Do you have any questions regarding our policies and procedures? _____________________________________________
Do you understand that your vet and personal references will be checked and a home check will be conducted prior to your being approved to act as a representative for Crest-Care, Inc?
_____________________________________________
If you are accepted as a representative for Crest-Care, Inc. please place a check by the activities you can do.
_______ long term foster ________ short term foster ___________ transportation
_______ fund raising ________ committee head ____________ board member
_______ shelter contact _________ other
I submit the above application. I understand that if I am not accepted as a member, the reason for the decision will not be disclosed to me. Also, if another rescue organization is doing a check, information Crest-Care, Inc. has obtained may be disclosed to those legitimate organizations.
If accepted as a Crest-Care, Inc. member I agree to abide by the Polices and Procedures of Crest-Care, Inc. I will maintain the Mission Statement and will abide by the rules set forth by Crest-Care, Inc. I will turn over to the treasurer any money (adoption or donation) that I receive for Crest-Care, Inc. Additionally, I certify I am in good standing with the American Kennel Club and I am at least 21 years of age.
Signature: __________________________________________ Date: _______________
