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  Prospective Owner Application

Thank you for your interest in adopting a Chinese Crested. We would appreciate you answering the following questions so that we can best determine compatibility between you and the Chinese Crested. All questions on this application must be answered for your application to be considered. If a question does not apply to you, please mark the question "N/A". Any question not answered will cause your application to be rejected. Thank you for your assistance and cooperation.

Your Name:

Email Address:

Address:

City:

State:

Zipcode:

Home Phone with area code:

Work Phone with area code:

Fax with area code:

Best time to contact you:

Occupation:

List name and age of all members of your household:

Do each of the members of your household agree/approve of having a chinese crested? Yes No

Do you own or rent your home? Own Rent

Choose one:

If "yes" to rent, what is the phone number with area code of your landlord?

Do you have a fenced home or area for the dog (please describe):

If no, what arrangements will you have for the dog's exercise and toilet duties (please describe):

Where will the dog be during the day?

Where will the dog be a night?

On average, how many hours per day will the dog spend alone?

Where will the dog be while you are out of town?

List breed, sex and age of each pet that you currently own:

Are they spayed or neutered: Yes No

Do your pets have any characteristics that we should be aware of:

Contact information of veterinarian:

Veterinarian Address:

Veterinarian Phone with area code:

If you do not currently have a dog, describe the last dog you owned and what happened to it:

Why are you interested in owning a chinese crested?

Please explain what you know about the characteristics and temperament of the chinese crested:

Explain what is involved in grooming and maintenance:

Have you ever owned a chinese crested before? Yes No

Have you ever owned a toy breed before? Yes No

If not, are you willing to learn and not hesitate to call a CCCN member with questions or concerns? Yes No

Are you committed to caring for this dog for its lifetime (average of fifteen years, or more)? Yes No

Do you have a preference of age, sex, color, hairless, powderpuff?

Would you be willing to adopt a chinese crested with medical problems or with a handicap? Yes No

With behavioral problems? 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

How much are you prepared to spend on your pet annually (vet care, vaccinations, food, grooming, heartworm preventive, training, etc.)?

Are you aware of the local ordinances where you reside (lease laws, vaccinations required, shelter, food, water)? Yes No

Are you aware that there is an adoption fee of a minimum of $250 which will support future rescues of chinese cresteds? Yes No

I understand that a member of CCCCN or an appointee, at CCCN's option, will conduct a home visit prior to my being approved to adopt? Yes No

How did you find out about the pet you want to adopt?

How did you find out about the Chinese Crested Club of Nashville?

Any additional comments or information that you would like us to consider in placing a chinese crested with you?

Please list two non_relative references:

Reference #1 Name:

Email Address:

Address:

City:

State:

Zipcode:

Phone with area code:

Relationship to you:

Reference #2 Name:

Email Address:

Address:

City:

State:

Zipcode:

Phone with area code:

Relationship to you:

I acknowledge that all the information on this form is true and correct and that the CCCN rescue has my permission to contact my employer, veterinarian, and references in order to process my application.

Thank you again! Your interest in CCCN rescue is deeply appreciated.

OFFICERS

President _ Jean M. Scott
Vice President _ Darlene McDonnell
Secretary/Treasurer _ Valarie Faulk

BOARD OF DIRECTORS

 Dick Dickerson
Russell Faulk
Skip Zeller
Suesie Zeller

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