Crest Care Printable Form
To send the application via email, click here
Please mail to:
Crest-Care
192 Parkers Corners Rd
Princetown, NY 12306
CREST-CARE, Inc
Representative Application
NOTE: failure to complete required questions will result in application not being processed.
CREST-CARE, INC. Representative Application
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 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.
Occupation _______________________________________________
Business Phone _____________________________________________
Marital Status _______________________________________________
If you have a significant other, does that person approve of your involvement with our organization? ______
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 phone )__________________________________________
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 type of animal and age for each animal permanently in your care.
_______________________________________________________________________________
List type of animal 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? ______________________
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: _______________
