Adopt ~ A ~ Setter


Name  ________________________________________________________________






How long have you lived there?_________________________________________    


Email address_________________________________________________________


With whom are you/spouse employed?____________________________________



How long have you worked there?_______________________________________


Phone (day) _________________ Phone (night) __________________________


Members of household and their ages: _________________________________




Other pets, their breeds, names and ages: ____________________________




Veterinarian's name and phone: _______________________________________




Do you own_____ rent _____ your house ____ apartment _____ condo _____


Do you have a pool? ______  In the ground or above?___________________


If in the ground is it separately fenced?_____________________________


Do you have a fenced yard?  __________________________________________


If yes, height of fence _________ size of fenced in area______________


Type of fence?________________________________________________________


If you do not have a fence, how and where will the dog be exercised and


Be allowed to eliminate?_______________________________________________


Neighborhood type:  city __________ suburb __________ rural __________


If you are renting, name and phone of landlord: ______________________




Where will the dog live during the day? ______________________________


At night? ____________________________________________________________


Is an adult family member home during the day?  ______________________


If not, give hours dog will be left alone  ___________________________


Have you owned a dog before?  _____ If yes, please give details (breed,


where did you get it, what happened to it?) __________________________








Do you plan to change the name of your new dog?_______________________


Have you ever crate-trained a dog? ___________________________________


Have you ever taken an obedience course with a dog?  _________________


Preferences for adoption: male __ female __ age range ________________


Would you consider a special needs dog, for example, one that requires

medication, one that needs obedience training? _______________________


What do you know about the Irish Setter breed?________________________


Who referred you to us?_______________________________________________


Who will be the primary care person for this dog?_____________________


What are your plans and goals for this dog?___________________________


Briefly tell us why you want an Irish Setter _________________________





I certify that the above information is true and I understand that, prior to the placement of an Irish Setter in my home, the above information may be verified. I also agree to a personal interview with a member
of the Irish Setter Rescue Program, if requested, to determine the suitability of my home to care for an Irish Setter.

Signature ____________________________ Date ______________________


Please return to:  Deanna Cuchiaro