WILLOW SPRING DOG RESCUE APPLICATION

Terry, Candy and Jonathan Smith

479 E. Cherry Rd.

Quakertown, PA 18951

(215) 538-2179

jcsmith49@comcast.net

 

Name _______________________________________________________________________

 

Address _____________________________________________________________________

 

Phone # _____________________________________________________________________

 

Number of adults in the house hold _____

 

Number of children in the house hold _____

 

Hours per day, on a regular basis, that dog will be alone _____

 

What is your plan for dog's exercise _______________________________________________

 

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Where in your home do you plan to keep the dog's crate _______________________________

 

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What other dogs do you own and what are their ages __________________________________

 

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Dogs you've owned in the past, how old were they when they left you and why ______________

 

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Treating Vet's Signature  _________________________________________________________

 

Vet's Name ___________________________________________________________________

 

Vet's Address _________________________________________________________________

 

Vet's Phone # _________________________________________________________________

 

Vet's Email ___________________________________________________________________