IRWSAA Adoption Form

Contact Info
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Phone Number *

Area Code Phone Number

Lifestyle
Occupations *
Members of household & their ages *
Current pets, Breeds, & Ages
Is an adult family member at home during the day? *

Yes No

Veterinarian Info
Veteranarian's Name *
Veteranarian's Phone *

Area Code Phone Number

Housing
Do you... *

Own Rent
Type of Housing *

Apartment Condo House
Landlord's Name *
Landlord's Phone *

Area Code Phone Number
Is your yard fenced? *

Yes No
Height of fence *
*In Feet
Size of Yard *
*In Square Feet
Where will the dog sleep at night? *
If outside, describe shelter

Previous Experience
Have you owned a dog before? *

Yes No
Please provide details (breed), how you acquired it, what happened to it.
Have you crate trained a dog? *

Yes No
Have you taken an obedience course with a dog? *

Yes No

Preferences for Adoption
Gender *

Male Female Either
Age Range *
Ex. 3-5 Years
How did you hear about our Rescue Program? *
By entering my initials here I certify that the above information is true and I understand that, prior to placement in my home, the above information maybe verified. I also agree to a personal interview with a member of the Irish Red and White Setter Association of America, if requested, to determine the suitability of my home and my ability to care for an Irish Red and White Setter. Any questions please feel free to contact Ciesla Tammy at Tammycedar@hotmail.com. *
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