(Please Note: Applicants that pass the veterinarian and personal reference check will be requested to furnish their drivers license number via phone or US postal mail (applicants choice) to their Coordinator, prior to Approval to Adopt, or to becoming a Representative of Crest-Care Inc. The information will be kept confidential with the exception of law enforcement/background check to determine if the applicant has any record of abuse or neglect toward any animal left in their care.

Work Phone:

Best time to call:

Home Phone:

Best time to call:

Fax Number:

Accept Collect Calls? Yes No

Date of Birth *Must be at least 21 years of age to adopt*

Occupation:

Do you live in a:

House

Apartment/Condo

Mobile Home

Other

Do you Own Or Rent

If yes to rent, does the landlord allow dogs?

Yes No Not applicable

Landlord's Phone (If you rent and do not supply the landlord's phone number, this application will not be screened):

Do you have a fenced yard? Yes No

If no, what arrangements will you have the dog's exercise and toilet duties?

WILL ADOPTING A CREST-CARE DOG PUT YOU OVER THE LIMIT OF PETS ALLOWED BY YOUR CITY OR TOWNSHIP?

Is there a particular Crest-Care dog you are interested in adopting?

Are you married or co-habitating with a significant other? Yes No

Does your partner/spouse know of and approve of the adoption? Yes _ No

Do you have children? If so, how many?

What your the ages of your children?

Are you or other household members allergic to dogs? Yes No

List all other dogs in the household (including breed, age, and sex)

Do you breed? If so, what breed?

How many litters per year?

Are your dogs/cats spayed/neutered? Yes No

Vet's name:

Vet's street address:

Vet's City, State and Zip Code:

Vet's phone number:

How many hours on average will this dog spend alone at home?

If you have had a dog before, describe the last dog you owned and what happened to it.

Tell us anything else about your family you'd like us to know.

Why are you interested in a Chinese Crested?

Have you owned a toy breed before? Yes No

Have you owned a Chinese Crested before? Yes No

If no, are you willing to learn and not hesitate to call a Crest-Care memver with questions or concerns?

Yes No

Are you familiar with the characteristics and temperament of the Chinese Crested?

Yes No

Are you familiar with the grooming and maintenance of the Chinese Crested? Yes No

Are you committed to caring for this dog for its lifetime? Yes No

Do you consider yourself financially stable enough to provide proper diet and medical care for a Chinese Crested, including emergency treatment if necessary? Yes No

Are you aware that there is an adoption fee which will support future rescues of Chinese Cresteds?

Yes No

How did you hear about Crest-Care?

Which sex of dog are you interested in? Male __________ Female ________ No Preference

Variety of Chinese Crested: Hairless�

Hairy Hairless Powderpuff No Preference

Age preference? Puppy Young adult Adult Senior No Preference

Would you consider a Crested with medical problems (special needs) or limitations?

Yes No Depends upon condition

Generally speaking, what kind of temperament are you looking for in a Chinese Crested?

What qualities appeal to you about the Chinese Crested?

Where will the Chinese Crested stay when it's alone?

Where will the Chinese Crested sleep?

Please tell us of any other expectations or concerns you may have.

Would you be willing to assist a Chinese Crested in need for Crest-Care if the need arises?

Yes No

Would you be interested in becoming a Representative for Crest-Care? Yes No

Please add any additional comments for consideration here.

Personal Reference Name (please use a reference other than immediate family)

Personal Reference Address

Personal Reference City, State & Zip Code

Personal Reference Phone Number

Best time to call?

I understand that a Crest-Care member will conduct a home visit prior to my being approved to adopt?

Yes No

Would you be interested in adopting adopting a dog from another part of the country? (This would involve paying for the dog's transportation (flight, health certificate, crate), in addition to adoption fee).

Yes No

How far are you willing to travel to obtain a rescue approved for adoption?

Due to the increasing cost of ground transportations, would you be willing to assist Crest-Care's representatives with gas costs associated with transporting your approved adopted dog from it's foster home to you?

Yes No Dependent upon distance of transport

Have you applied to adopt with Crest-Care previously? Yes No

If Crest-Care does not have a Chinese Crested in need suitable to your home, would you be willing to be referred to another rescue organization or private rescue of Chinese Cresteds? Please note that referral does not mean that Crest-Care approves or endorses any organization/private rescue to whom we may refer you. Therefore, by checking yes, you are releasing Crest-Care, Inc. of any and all liability and/or responsibility if this application is referred to another group or private rescue. Yes No

If you are a retired person or a senior citizen we ask that you specially consider an older (type of dog) to adopt. These dogs remain puppyish well into old age and can also live a long time. We want them to have their family right up until the end. The most frequent reason for a pet animals' later life abandonment is that their caregiver has to leave them for a nursing home and their family members do not always have space, desire or the ability to care for a pet left displaced by such an event. Please think about how YOUR age and state of health will affect your new dogs' future

All required areas must be completed or the form will not send.

We Reserve The Right to Refuse An Applicant

Crest-Care, Inc.