Application to   FOSTER and/or ADOPT an Irish Setter

Name:    

Email Address:                   

Re-enter Email Address: 

Street Address: 

City:    State:    

ZIP:          Phone: 

Rescue dog will spend a majority of time:  ? Indoors Outdoors   

If indoors, dog will be: ? Loose Crated

If outdoors, dog will be:   ? Fenced - physical Unfenced Fenced - Invisible Kennel run (uncovered) Kennel run (covered)    

Height of fence (feet): 

How many members are in your household? 

I have children:  under five: six to nine: ten and older:

Who will be spending time with the rescue dog?   

How many hours per day?

I have other pets:  dogs   cats   birds   other:

Have you ever owned an Irish Setter?  ? Yes No   

Ever trained an Irish Setter? ? Yes No

Current Veterinarian Information:

Vet Name:                

Vet Phone:

Emergency Vet Clinic:           

Emergency Clinic Phone:

Comments/Suggestions/Questions:

I Certify that I have read, understand and agree to the following statements:

1. The information I have provided above is true and complete.

2. 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.

3. A representative of the Irish Setter Club of Houston Inc. 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.

4. 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.

5. I have reviewed the Clubs Privacy Policy.

6. 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!!