Date
Name:
Spouse's Name
Email Address:
Minimum age requirement for Crested Guardians representatives is 21. Do you meet this requirement?
Date of Birth
Daytime Phone Number
Evening Phone Number
Cell Phone Number
Best time to call/phone number preferred to receive call?
Fax
Email Address
Address - Please Include State
Do you live in an apt/condo, house, mobile home?
Do you rent or own?
If rent, does your landlord allow pets?
If rent, landlord's phone number
Is your yard fenced?
If no, please describe dog's toilet duties.
How many pets are in your home?
Please list types of pets: Breed, Age, Gender, Names Ex: Kiwi (Chinese Crested) Age: 4 Gender: F
Does your community restrict the number of animals allowed on your property?
If there is a restriction, how many are allowed?
Number of children in home and their ages (please be sure to list ages):
Is anyone in your home allergic to dogs?
Veterinary Reference - Vet's Name
Veterinary Reference - Vet's Phone Number
Veterinary Reference - Vet's Address (Include State)
Are your dogs/cats spayed or neutered?
If they are not spayed/neutered, please give reason.
Do you breed or have you ever bred dogs?
Have you ever owned a Chinese crested?
If so, when?
If you have never owned a Chinese crested, are you familiar with the breed? Please explain.
Why are you interested in becoming a Crested Guardian Representative?
Would you be able to assist in any of the following? Please check all that apply:
Do you have a special skill/experience that you feel might benefit Crested Guardians?
Where did you hear about Crested Guardians? (Please be as specific as possible):
If you are able to foster - Can you afford quality food and supplies for the foster dog in your care?
Can you afford unexpected medical expenses (until reimbursement) should the dog become ill or injured?
If you are able to foster - Where would foster dog sleep?
If you are able to foster - Where will dog stay when alone in home?
If able to foster - How many hours a day will dog be left alone?
If you are able to foster - Would you consider a foster dog with physical limitations?
Do you agree to a home visit as part of the application process?
Are you a member of a kennel, training or other rescue organization?
If so, list your duties and responsibilities as a member:
Personal Reference #1 Name
Personal Reference #1 Address (Include State)
Personal Reference #1 Phone
Personal Reference #1 Best Time To Call
Personal Reference #2 Name
Personal Reference #2 Phone Number
Personal Reference #2 Address
Personal Reference #2 Best Time Call
It is very important that you inform your Veterinary and Personal References to let them know we will be contacting them. Your vet will not release any information to us without your authorization. Not notifying your reference can delay the application screening process. Please type YES here stating that you have read and understand this.
Applicant's signature (Type full name):
Crested Guardians, Inc reserves the right to deny any application. Please type your initials showing you have read this statement.
