Name:
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Email Address:
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Please re-enter your Email Address:
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Street Address:
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City:
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State:
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ZIP:
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Phone:
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Rescue Dog will spend a majority of time?
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If Indoors, dog will be?
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If outdoors, dog will be?
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Height of fence (feet):
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How many members are in your household?
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Please list number of children and their ages?
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Who will be spending time with the rescue dog?
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How many hours per day?
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Please list/describe your other pets?
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Have you ever owned an Irish Setter?
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Have you ever trained an Irish Setter?
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Vet Name:
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Vet Phone:
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Emergency Vet Clinic Name:
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Emergency Vet Clinic Phone:
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Comments/Suggestions/Questions:
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By clicking on the "Certify/Submit button" below, I
Certify
that I have read, understand and agree
to the following statements:
-
The standard fee for adopting a Rescue Irish Setter is
$200.00, sometimes more in special circumstances. This fee is used
to help defer our veterinary, transport, and care expenses. We are an
all-volunteer, non-paid organization and we DO NOT profit from the placement of
Rescue Irish Setters.
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The information I have provided above is true and complete.
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My Veterinarian will be contacted to verify the
information provided above. I hereby authorize my Veterinarian to
disclose any appropriate information required to verify my ability to
accept and care for a rescue Irish Setter.
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A representative of the Irish Setter Club of Houston will contact me to schedule a home visit to verify the information provided
above. I understand that this home visit is a condition of adoption.
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The information provided on this application form, the results
of the Veterinarian interview, and the results of the home
visit will only be disclosed to members of the Irish Setter Club of Houston,
Inc. Rescue Committee.
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I have carefully read the
Irish Setter Club of
Houston Rescue Contract
and I understand that it is a legally binding
document and that I will be required to sign it before receiving a Rescue
Irish Setter.
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I have reviewed the
Clubs
Privacy
Policy
.
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Please double-check your email address as entered
above!
This is how we will contact you.
Thank you for your interest in helping a Rescue Irish
Setter!
Please press the Certify/Submit button only once.
It may take a minute or so for the application to process.
Thanks!
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