List all ADULT FAMILY members who currently reside in the household by name, age, and occupation, INCLUDING YOURSELF:

Name

Age

Occupation

List all ADULT (NON-FAMILY) members who currently reside in the household by name, age, and relationship to you:

Name

Age

Relationship

List all RESIDENT children under 18 years of age by name, age and relationship to you:

Name

Age

Relationship

List other children under 18 years of age who VISIT FREQUENTLY by name, age, relationship, frequency and typical duration of visitation:

Name

Age

Relationship

Duration and Frequency

If you rent, provide the following information:

Where will the dog be kept during the day?

Special Needs dogs could be of any age. They could be a dog with a vision or hearing loss, or have some other medical condition. They could be dogs in their twilight years who need a loving home for the rest of their lives.

Please note that your choices will be limited if you must concentrate on one small geographic area. You will have more options if you are willing and able to adopt from a larger geographic area. We will provide you with more information on our specific transport policies for our rescues, but in summary, you are responsible for transporting your future rescue dog to your home - both financially and logistically. We can help you plan this, and your rescue's foster family may be able to help with the transport, (note that we request 15 cents per mile fee for any volunteer who helps transport your dog to you - more on that later), but the final responsibility is yours. Flying your rescue dog is an option for some of our rescues but not all. 

FOUR PERSONAL REFERENCES ARE REQUIRED in addition to your current veterinarian. Only one of these references may be a family member. All references must be 21 years of age or older. NOTE: If you do not provide 4 personal references, your application will be rejected.

REFERENCE 1                        

REFERENCE 2

REFERENCE 3

REFERENCE 4

If you have had pets in the past, list the information for the vet that cared for them. Also include an additional Veterinary reference if you have used your current Vet for fewer than 4 years.

If you do not currently have a vet, provide the information about the vet that you will be using when you adopt a dog.

VET REFERENCE 1

VET REFERENCE 2

Where did you hear about us?

Are you able and willing to make a Rescue Adoption donation if you adopt a rescue dog through Col. Potter Cairn Rescue?

PLEASE NOTE: At the time you adopt one of our rescue dogss, you will be asked to make a donation to CPCRN. This donation helps defray shelter fees and other costs paid to procure our Rescues, the cost of transporting them to our foster homes, the costs of providing them with food and appropriate veterinary care, including spay/neuter, immunizations, heartworm testing and prevention, and other medical and/or grooming needs as are required by the particular dogs in our program. As adoption donations do not constitute purchase monies paid for the Rescue, they are not refundable in the event that you decide to return the Rescue or for any other reason.

By submitting this application, you give us your permission to call all of your listed references, including your Veterinarian(s), to determine responsible pet ownership. If you have included a work telephone number for any of your references, you are stating that they may receive telephone calls at their place of employment.

Your signature(s) will be required on a formal Adoption Contract prior to adopting any rescue dog. You must also provide proof of being of legal age in your state to sign contracts. Photographic identification with your current address may be required prior to adoption.

I understand that CPCRN may, at its sole discretion, determine that a Cairn rescue will not be approved for adoption by me or my family.

Please make sure the application is complete and you have entered your e-mail address before pressing the "Submit" button below. Incomplete applications may be rejected or delayed.

PLEASE NOTE: Adopting one of CPCRN's rescue dogs is a multi-step process. Please see our Frequently Asked Questions for details on how the adoption process works.

I represent that the information that I have provided on this form is the truth to the best of my knowledge and belief. I/we hereby give my/our permission to CPCRN to use any of the above information to confirm that this rescue application is deemed to be correct. I hereby certify that I have not been convicted or otherwise been found guilty by any governmental authority of animal cruelty, neglect or abandonment, or of failing to provide adequate shelter to an animal.