I want to Rescue an Irish Terrier

Please Note
This is NOT an application form to rescue an Irish Terrier.
We need to have some detailed information about you and your experience with dogs.
This is merely a qualifying procedure.  An application may follow later.

Rescue dogs need homes which provide a safe environment for their adjustment.
Children, cats and yards that are not fenced may not provide the best situation for a successful rescue.
That is why we do not place them in these homes unless we know the dogs came from a similar
environment and it was successful for that dog.   Unfortunately, that
background information is not always available to us.

Most of the dogs needing new homes, love and attention, are mature dogs,
often 7 years and up.  Irish Terriers, it should be noted, are a very healthy breed
and remain full of vim and vigor, often well past the age of 13.

Please note that we appreciate you sending the information,
and although we try to respond to all, sometimes it is not always possible.

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Information Required
Certain Fields are Required.
If you don't fill them in you will get an error message
and the form will not send!

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Your Full Name:  (Required)
Street & No. or Box Address:  (Required)
Address Continued:  (Optional)
Town or City:  (Required)
State or Province:  (Required)
Zip/Postal Code:  (Required)
Phone No:  (Required)
e-mail:  (Required - Be CASE accurate!)
E-mail Repeated:  (Required)

All of the following questions require answers.

Brief Dog History
Have you ever owned a dog?	Yes     No
Do you presently own a male dog?	Yes     No
What breed is he?"
How old is your male dog?	Indicate His Age One Two Three Four Five Six Seven Eight Nine Ten Eleven Twelve More than Twelve
Has your dog been neutered?	Yes     No
Do you presently own a female dog?	Yes     No
What breed is she?"
How old is your female dog?	Indicate Her Age One Two Three Four Five Six Seven Eight Nine Ten Eleven Twelve More than Twelve
Has your female dog been spayed?	Yes     No
Have you ever had an Irish Terrier?	Yes     No
Have you ever had a terrier?	Yes     No
If you have had, or now have a terrier - What breed(s)? Hold CONTROL KEY down to select/de-select more than one.	None Airedale Amer Staffordshire Australian Bedlington Border Terrier Bull Mini Bull Standard Cairn Cesky Dandie Dinmont Fox Smooth Fox Wire Glen of Imaal Irish Terrier Kerry Blue Lakeland Manchester Standard Norfolk Norwich Parson Russell (Jack) Schnauzer Mini Scottish Sealyham Skye S C Wheaten Staffordshire BT Welsh Westie
How many dogs have you had in the last 10 years?	How Many Dogs? None One Two Three More than three
Additional dog related experience - Please give details.
Your Habitation
Do you have a house?	Yes     No
If you have a house, is the backyard fully fenced?	Yes     No
Inhabitants of your house
How many adults over age 17 yrs?	Indicate One Two Three More than three
How many people between 6 & 16 yrs?	Indicate None One Two Three More than three
How many children under age of 6 yrs?	Indicate None One Two Three More than three
Do you presently have a cat?	Yes     No
Do you have any other animals, not a cat or dog?	Yes     No