WILLOW SPRING DOG RESCUE APPLICATION
Terry, Candy and Jonathan Smith
479 E. Cherry Rd.
Quakertown, PA 18951
(215) 538-2179
Name _______________________________________________________________________
Address _____________________________________________________________________
Phone # _____________________________________________________________________
Number of adults in the house hold _____
Number of children in the house hold _____
Hours per day, on a regular basis, that dog will be alone _____
What is your plan for dog's exercise _______________________________________________
_____________________________________________________________________________
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Where in your home do you plan to keep the dog's crate _______________________________
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What other dogs do you own and what are their ages __________________________________
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Dogs you've owned in the past, how old were they when they left you and why ______________
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Treating Vet's Signature _________________________________________________________
Vet's Name ___________________________________________________________________
Vet's Address _________________________________________________________________
Vet's Phone # _________________________________________________________________
Vet's Email ___________________________________________________________________