Stickney Toy Breed Rescue and Retirement Sanctuary
5675 S.W. 42nd Road
Cortland, Ne 68331
402-613-4306/mary@stickneys.net
ABOUT YOU
Names of all adults in household:
APPLICANT: First Name Last Name
CO-APPLICANT: First Name Last Name
Address:
City: State/Province: ZIP/Postal Code:
Email Address:
Home Phone: Work Phone:
Best Time to Call: Where? Home Work
Number of persons in your household and their ages:
Adults: Children:
ABOUT YOUR HOME
Type of Dwelling House Apartment Trailer
Do you Own or Rent your home?
If you rent, do you have your landlord's permission to keep a dog? Yes No
(We will require a letter from your landlord evidencing this permission.)
Do you have a yard? Yes No
If yes, How large is your yard?
Is your yard fenced? Yes No If yes, how high is the fence?
Do you have a dog kennel run? Yes No
If yes, how large is it?
If yes , do you plan on the dog living 100% of the time in the kennel? Yes No
Where will the dog sleep?
Do you plan to use a dog crate? Yes No
If yes how many hours per day will the dog be crated?
Please explain why or why not?
Are there currently animals in your home? Yes No
List current animals:
RESCUE DOG PREFERENCES
Please indicate here any preferences you have for adopting a rescued:
I would prefer a: Male Female Either gender rescue dog.
Would you be willing to adopt a dog with health problems (non-infectious)?
Yes No
If yes, to what extent would you be willing to help a sick dog?
List your personal and Veterinary References here: