Rescue Adoption Application - Online

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NOTE: Items marked with an asterisks are required fields.

Contact Information

First Name(s): *

Last Name: *

Address

Street Address:

Address Continued:

City:

State: *

You must tell us where you are from. If non-US resident, use the "Other" choice listed.

Zip:

Email: *

Daytime Phone:

Use the following format: xxx xxx xxxx

Evening Phone: *

Use the following format: xxx xxx xxxx

What preferences do you have?

Sex:

Age:

Would you consider a dog with special health needs?

Information About You & Your Family

Please note that your answers to some questions may trigger additional questions.

Type of Home: *

If you answered "Other" to Type of Home, please describe:

Do you rent or own? *

Do you have a statement from your landlord allowing pets?

Do you have a fenced yard? *

Type of fencing:

What is the approximate fenced area?

Since you do not have a fence, how will the dog exercise & take potty breaks?

Where will your dog stay during the day?

Where will your dog stay at night?

Number of adults in the home: *

Do all adults work outside of the home?

Do you have children under the age of 18? *

Number of children in the home:

Ages of children: 0 to 5 years;5 to 10 years;10 to 15 years;> 15 years

Select all that apply

Approximately how many hours of the day will the dog be left alone?

Do you currently have other animals? *

How many dogs do you have and what breeds are they?

Please describe what you mean by "Other" animals:

Have you owned other pets in the past? *

Please explain why the pet(s) is no longer with you.

Do you have a Veterinarian? *

Veterinarian Name:

Vet. Phone Number:

Please tell us

How do each of the family members feel about a Toller joining the family? *

Why are you interested in owning a Nova Scotia Duck Tolling Retriever?

Agreements - Certification

All our dogs are spayed or neutered before adoption. If for any reason, you are not able to keep a dog that you obtained through the NSDTRC (USA) Rescue, you agree to return the dog to NSDTRC (USA). The NSDTRC (USA) reserves the right to remove a dog if the dog is being neglected or abused. If the dog that you adopt has a registration certificate, this document will not be transferred to you.

By completing this application you are agreeing to be contacted by a NSDTRC (USA) Rescue Volunteer by phone and to a home visit to determine that your accommodations are safe and appropriate.

Fees: A fee of $325.00 must be paid before a dog will be placed in your home. This fee covers rescue expenses. A veterinarian will have examined the dog, heartworm tested, fecal tested, spayed/neutered, and provide any necessary inoculations.
Transportation: Every effort will be made to minimize transportation expenses but air transport will be at your expense.

I certify that I am at least 18 years of age, that the information presented in the application is accurate, and agree to the agreements and fees. * YesNo

Your Name: *

Name of person completing the form.

When you "Submit" this form, you will have the opportunity to review your answers and make any corrections prior to final submission. You will receive a confirmation email that we received your information.

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Nova Scotia Duck Tolling Retriever Club (USA)

Rescue Adoption Application - Online