My name is Rebecca!

Rebecca is about 4-6 years old. She is a golden/poodle mix. Also known as a golden doodle. She is a very sweet and social girl. She is very friendly and loves everyone she meets. Rebecca is a total love bug! She gets along with most dogs but is selective with other female dogs. She has been retired from breeding and now is looking for a forever home. Since she has not been around small children so we think a home with older kids(10 and over) would be best for her. She has started leash training and crate training. She will need more house training. Everything in the house is new to her but she is adjusting well. Rebecca will be spayed, given a dental, heart worm tested, given her 7-way vaccine, a rabies vaccine, wormed, and on heart worm and flea prevention before going to her forever home. Her adoption fee is 425.00 and that includes all the vetting we have put into her. If you are interested in learning more about her please email changingheartsrescue@aol.com.

If you are interested in adopting her you can copy and paste the application below in an email fill it out and email it to changingheartsrescue@aol.com.

Contact Information

Full name: _______________________________________________________________

Occupation: ______________________________________________________________

Address: ______________________________________________________________

How long at this address: ¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬___________________________________________________

Daytime Phone: ___________________________________________________________

Evening Phone: __________________________________________________________

Best time to call: ___________________________________________________________

Email address: __________________________________________________________


Family & Housing

How many adults are there in your family (their relationship to you)?
_________________________________________________________________________

How many children (ages)?
_________________________________________________________________________

What type of home do you live in single family, town home, apartment, farm, etc.?
_________________________________________________________________________

Please describe your household: __ Active __ Noisy __ Quiet __ Average



If you rent, please give the rules governing pets and the landlord’s name and number:

(By providing this information you are allowing CHR permission to contact your landlord please inform them of this call so they will speak with us)

Does anyone in the family have a known allergy to dogs? _________________________

Is everyone in agreement with the decision to adopt a dog? _________________________

Do you have time to provide adequate love and attention? _________________________

Other Pets

What other pets do you have (specify type and number)?


Are these pets up to date on vaccines? _________________________________________

Are these pets spayed/neutered? If not. Why? ____________________________________

_________________________________________________________________________

Have you every surrendered a pet? If so, why?

_________________________________________________________________________

Have you ever had a pet euthanized? If so, why?

_________________________________________________________________________

Have you ever lost a pet to an accident?

_________________________________________________________________________

How do you discipline your pets and why?

_________________________________________________________________________


Veterinarian

Do you have a regular veterinarian? __ Yes __ No

Veterinarian’s name: _______________________________________________________

Clinic Name: _______________________________________________________

Clinic Address: ________________________________________________________

Clinic Phone: ________________________________________________________

(Providing CHR with this information you are allowing CHR to call your vet. Please call your vet and ask them to authorize the release of information to CHR.)
About the Dog You Wish to Adopt

What is your idea of an ideal dog and why?

Desired age: __________ Desired Size: _____________________________________

Desired breed: _______________________________________________________________

Breed you would not adopt: _____________________________________________________

Desired sex: _ Spayed Female _ Neutered Male _ No preference

Willing to adopt: __ outgoing/hyper dog __ shy dog
__ Dog that needs regular medication __ dog that needs training
__ Dog that needs grooming __ none of these




Where will the dog spend the day? (Describe)
_________________________________________________________________________

Where will the dog spend the night? (Describe)
_________________________________________________________________________

Number of hours (average) dog will spend alone? _________________________________

Who will have primary responsibility for this dog's daily care? _______________________

Who will have financial responsibility for this dog? ________________________________

Do you agree to provide regular health care by a Licensed Veterinarian? __ Yes __ No

Do you agree to keep the dog as an indoor dog? __Yes __No

When the dog goes out, how do you plan to supervise it? Fenced yard?

Do you agree to contact CHR if you can no longer keep this dog? __Yes __No

Are you be willing to let a representative of CHR visit your home by appointment?
__Yes __No

How did you hear about CHR? _____________________________________________________

Would you be interested in fostering? __Yes __No __Would like to know more
Personal References
Please list someone who is familiar with both you and your pets.

Name:
Address:
Phone:
Relationship (relative, neighbor, friend, etc.):

Name:
Address:
Phone:
Relationship (relative, neighbor, friend, etc.):

All of the information I have given is true and complete. This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian.

___________________________ _________
(Signature) (Date)