Stickney Toy Breed
Rescue and Retirement Sanctuary
5675 S.W. 42nd Road
Cortland, Ne 68331
Names of all adults in household:
APPLICANT: First Name
CO-APPLICANT: First Name
Home Phone: Work
Best Time to Call:
Where? Home Work
Number of persons in your household and their ages:
ABOUT YOUR HOME
Type of Dwelling
Do you Own
or Rent your home?
If you rent, do you have your landlord's permission
to keep a dog? Yes
(We will require a letter from your landlord
evidencing this permission.)
Do you have a yard?
If yes, How large is your yard?
Is your yard fenced?
Yes No If yes, how high is the
Do you have a dog kennel run?
If yes, how large is it?
If yes , do you plan on the dog living 100% of the
time in the kennel? Yes
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
Please explain why or why not?
Are there currently animals in your home?
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
Would you be willing to adopt a dog with health
If yes, to what extent would you be willing to help
a sick dog?
List your personal and Veterinary References here: