Rep App 2

To send the application regular mail: click here

NOTE: failure to complete required questions will result in application not being processed.

Crest-Care, Inc.

Representative Application

Name:
Address:
City:	State: Zip:
Home Phone:	Best Time to Call:
Work Phone:	Best Time to Call:
Fax Number:
E-Mail:	(required)
Date of Birth	*must be at least 21 years of age to adopt
Please Note: Applicants that pass the veterinarian and personal reference check will be requested to furnish their drivers license number via phone or US postal mail (applicants choice) to their Coordinator, prior to Approval to Adopt, or to becoming a Representative of Crest-Care Inc. The information will be kept confidential with the exception of law enforcement/background check to determine if the applicant has any record of abuse or neglect toward any animal left in their care.
Occupation: Business Phone:
If you have a significant other, does that person approve of your involvement with our organization? Yes No
Do you have children?
If yes, what are their ages?
Do you have children visiting often?
How long have you had Chinese Cresteds?
Personal Reference (name and phone)?	Name: Phone:
Personal Reference (name and phone)?	Name: Phone:
Vet reference (name and phone)?	Name: (required) Phone: (required)
Do you support spay and neuter contracts?
Do you own Chinese Cresteds? If yes, how many Do you breed Chinese Cresteds? If yes, how many litters per year? Do you breed any other breeds? If yes, how many litters per year
Do you breed any other type of companion animal? If yes, what kind and how many per year? What is the TOTAL number of animals housed at your home? WILL ADOPTING A CREST-CARE DOG PUT YOU OVER THE LIMIT OF DOGS ALLOWED BY YOUR CITY OR TOWNSHIP? List type of animal and age for each animal permanently in your care: List type of animal and age for each animal temporarily in your care: Have you prevoiusly adopted a dog on an adoption contract? If yes, where is the dog now? Do you own your property? If you rent, what is your landlord’s policy on animals? Landlord’s phone number: (required) Does the community you live in have any restrictions on number of animals allowed? If yes, what is that policy? Does your residence have a fenced area? If yes, what is the approximate size?
Are you a member of any kennel or training club?
If yes, what are the names of the clubs and what duties do you assume as a club member?
Are you a member of or do you support any rescue or animal rights organizations? If yes, what organizations and in what way do you support them?
Have you read Crest-Care, Inc.’s policies? Do you have any questions regarding our policies and procedures?	Yes No
Do you understand that your vet and personal references will be checked and a home check will be conducted prior to your being approved to act as a representative for Crest-Care, Inc?
In which of the following areas are you willing to work? (Check those that you are willing to work)	Contact Person for Shelters: Transportation: Committee Head: Board Member: Foster Home (Long Term): Foster Home (Short Term): Correspondence: Fund-Raising: Other:

I submit the above application. I understand that if I am not accepted as a member, the reason for the decision will not be disclosed to me. Also, if another rescue organization is doing a check, information Crest-Care, Inc. has obtained may be disclosed to those legitimate organizations.

If accepted as a Crest-Care, Inc. member I agree to abide by the Polices and Procedures of Crest-Care, Inc. I will maintain the Mission Statement and will abide by the rules set forth by Crest-Care, Inc. I will turn over to the treasurer any money (adoption or donation) that I receive for Crest-Care, Inc. Additionally, I certify I am in good standing with the American Kennel Club and I am at least 21 years of age.

Signature: Date:

Please be patient when submitting form; it can take a few minutes to process.

We Reserve The Right to Refuse An Applicant

Crest-Care, Inc.