Response-O-Matic Form

Silky Terrier Club of America Rescue Program

Pre-Adoption Application

ladybug If you are interested in adopting a Silky Terrier through the Silky Terrier Club of America (STCA) Rescue Program, please complete this form and submit it to us.

Please keep in mind that some of the Silkys listed on the web site are not in the STCA Rescue program, and if you are interested in one of those dogs, you must get in touch with the listed contact person directly.

You must complete the entire form. Submitting this form does not guarantee that a Silky will be placed with you.

If you have previously completed this form and you wish to apply for a newly posted Silky, please do not submit another application. Simply email me at SilkyRescue@yahoo.com and indicate which Silkys you are currently interested in and I will forward your application to the appropriate person.

 

Date:

Name:

Address:

Address:

City:

State:

Zip Code:

Email Address:

Please, please, please give us your correct email address! We don't want you to think we're ignoring your application, but we need your email address in order to respond. Your email address should look something like this: yourname@something.com

Home Phone:

Work Phone:

Cell Phone:

Reference: Please provide the name, address, and phone number of your veterinarian.

How long with this vet?

If less than one year with your current vet, please provide the name, address, and phone number of your previous veterinarian.

Why do you want to adopt a rescued Silky Terrier?

Please tell us about any previous experience you have had with Silky Terriers.

Do you own your home or rent?

OwnRent

If you rent, do you have your landlord's permission to keep a dog?

YesNoN/A

Do you have a securely fenced yard?

Yes No

What type of fence?

How high is the fence (at the lowest point)?

Please list the names and ages of any children who live in your home.

Please list the number and type of animals in your household.

Are you willing to sign a contract stating that the silky terrier will be an indoor dog, treated as part of the family, and given appropriate food, grooming, and veterinary care?

Yes No

Are you willing to sign a contract which absolves the Silky Terrier Club of America and all its members and/or contacts from liability concerning the adopted Silky Terrier?

Yes No

Have you or any member of your household ever been convicted of animal cruelty, neglect or abandonment?

Yes No

Please tell us what type of Silky Terrier you would consider adopting.

Sex:
Male
Female
Either male or female

Age: (Check all that apply.)
Less than 2 years old
2 to 5 years old
6 to 9 years old
More than 9 years old

If you are completing this form to apply for one or more specific silkys listed on the website, please list the name(s) of the silkys you are interested in.

If there is any other information you think we should have regarding your application, please list it here.


Thank You!


Please click on the Submit button to send this information to us.
By pressing the "Submit this Information" button, you attest that you have read the disclaimer on the previous page and agree to the terms therein. If you wish to review the disclaimer, click here. Otherwise, please click here to return to our home page.

 


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