New York Chesapeake Bay Retriever Rescue
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ADOPTION APPLICATION

Adopter's Name:
Street Address:

City:   State:       Zip:

Telephone numbers:

Home:    Work:

E-mail(s):



Why are you considering adopting a Chesapeake Bay Retriever?


You want to acquire a Chesapeake Bay Retriever for:

Hunting   Companionship   Breeding  Protection

Have you previously owned a Chesapeake? (and describe if you'd like)



Where would the dog be primarily housed?   
Inside      Outside      About equally inside and outside

Where would the dog stay when you are not at home?   
Loose inside  Crated or otherwise confined inside Loose outside  
Kennel run/fenced area outside  Tied/chained outside Other (describe)



FAMILY INFORMATION:
Marital Status: Married Single  Divorced

If married, is spouse in agreement about adopting a Chesapeake?

Number of children living in the house:
What is/are their ages:

Do they live with you full time?    

Other household members who will have contact with the dog:



Do you own other dogs?       (specify age, sex, breed)
 

    Cats?    __________  Other animals? __________


Household setting:   Rural       Suburban       Urban

Do you live in a:   house    apartment   mobile home   townhouse   Other - Please Describe: 

Do you own?       Do you rent?    

If you rent, you MUST provide proof of permission to have a dog on the premises.

Describe your yard (select all that apply):  

fenced    kennel run   no fence    Other (describe):

If fenced, what is the height of the fence and the approximate size of the fenced-in area:


Approximately how many hours each day would the animal be left alone?

Do you want to adopt a:  Male?   Female?    
(Adopted Chesapeakes must be spayed or neutered)

Age range?

How long are you willing to wait for a Chesapeake?

What qualities do you hope to find in the Chesapeake you adopt?

Would you describe your lifestyle as:
Very active/outdoor activities   Quiet/less active

Do you understand that Chesapeakes are quite active dogs and that although they are good indoor companions, they are a breed with moderate to high exercise requirements?
    


If not a previous Chesapeake owner, you have researched the breed through (choose all that apply):   
Books    Internet      Rescue Orgs.     Other (describe):

Are you willing to attend obedience classes with a Chesapeake?
    
 
Do you consent to a home visit and interview before adoption?
   

Do you consent to be contacted periodically for updates to assure that the animal successfully adjusts to its new home?
   

Please write any additional information you would like us to consider in placing one of our rescued Chesapeakes with you.

How did you locate NY CBR Rescue?

By electronically sending this application I acknowledge that applying does not ensure approval:

                   

You can contact us at:   
NY CBR Rescue, Inc., 2870 Chase Rd., Rock Stream, NY 14878
(607) 535-7069, chessy@onlineimage.com

Pet ownership is a serious commitment that the entire household needs to consider and agree to before the animal is adopted. We want to assure that each adoptive household is aware of, and willing and able to accept the physical and financial responsibilities of pet ownership. We appreciate your interest in adopting a Chesapeake Bay Retriever.

NY CBR Rescue
http://www.nycbrrescue.org