Stickney Toy Breed Rescue and Retirement Sanctuary

Mary Stickney

5675 S.W. 42nd Road

Cortland, Ne 68331

402-613-4306  / TheluckyOnes@MarysHouse.us

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:

Diet and Vet care:

I require that you feed either a home cooked diet , a raw diet or a super premium all human grade kibble. Or a mix of these items.

Proper nutrition will lengthen the life of your dog and you will have fewer Vet bills. I will provide you information on these diets.

Are you willing to do this?  Yes     No

Sample of a Super Premium dog food Ingredients names Innova:

Turkey, Chicken, Chicken Meal, Ground Barley, Ground Brown Rice, Whole Steamed Potatoes, Ground White Rice, Chicken Fat Preserved With Natural Vitamins E and C , Herring Meal, Whole Raw Apples, Whole Steamed Carrots, Cottage Cheese, Sunflower Oil, Alfalfa Sprouts, Whole Eggs, Whole Clove Garlic

I require that you take your dog to the Vet at least one time per year for

Annual vaccinations (to include Giardia and Lyme disease if you camp or live in the country).  Are you willing to do this?  Yes     No

I require that you give your dog heartworm preventives in either the pill or injection form.  Are you willing to do this?  Yes     No

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: