THE NATIONAL BORZOI RESCUE FOUNDATION
if not you, then who?
if not now, then when?
Name:
______________________________________________________________________________________
Address:
____________________________________________________________________________________
Phone
(home): _______________________________ (work):
__________________________________________
Email Address:
_______________________________________________________________________________
Occupation:__________________________________________________________________________________
Employer:___________________________________________________________________________________
How
long?: __________________ Employer's
Phone:
If Applicant is not head of household, who is?
______________________________________________________
Occupation:__________________________________________________________________________________
Employer:___________________________________________________________________________________
How
long?: __________________ Employer's
Phone:
TYPE OF RESIDENCE:
House ______ Apartment ______
Mobile Home ______ Condominium ______Other ______
If "Other", please
explain:_____________________________________________________
Do you rent:
______ or own: ______ If you rent, do you have your landlord's permissions
to keep a Borzoi?
YES ______ NO ______
How long at this address?
_______________________
OTHER PEOPLE LIVING AT THIS ADDRESS (children, relatives,
roommates, significant others, spouse, etc)
Please list ages if
under 21 years.
NAME
RELATIONSHIP
AGE
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
PLEASE LIST ALL CURRENT PETS: (dogs, cats, birds,
reptiles, etc)
SPECIES
NAME
AGE
SPAYED/NEUTERED (Y/N)
SEX
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Where
are these pets
kept?
Where
would you keep a
Borzoi?____________________________________________________________________
What
type of exercise would the Borzoi
get?__________________________________________________________
_______________________________________________________________________________________________
DOES ANYONE IN YOUR HOME HAVE ALLERGIES? YES
______ NO ______
If "yes", please
explain:_______________________________________________________________________
DESCRIBE YOUR YARD
Approximate Size:
_______________________________________________________________________________
Fence
type and
height:____________________________________________________________________________
How much time would the Borzoi spend outside?_______________________________________________________
Have you ever owned a Borzoi before? YES
______ NO ______
Or other large dog? YES
______ NO ______ What type?
What happened to them?
________________________________________________________________________
Have
you ever surrendered a dog to a shelter or taken one back to a breeder?YES
_________ NO _________
If "yes", please
explain:
Would you consider... (rate from 1 to 10, with 10 being the most
desirable)
Male ______ Female ______ Puppy (under 6
months ______ Puppy (6-12 months) ______
Over 5 years of age
______ From a shelter ______ With medical needs ______
Untrained ______
Borzoi mix ______ Other (Please explain
if we have missed
something):___________________________________
REFERENCES: (please include name, address, phone
number and email (if applicable))
Veterinarian:
____________________________________________________________________________________
Personal
References:
_____________________________________________________________________________
________________________________________________________________________________________________
Who in your home wants a Borzoi?
__________________________________________________________________
Who will
be the primary caretaker?
_________________________________________________________________
Would you consider foster care for a trial period? YES ______ NO ______
Do you understand that NBRF expects reimbursement of
expenses which include spay or neuter, vaccinations,
heartworm checks, and
other medical care in the amount of $300 per Borzoi? YES
______ NO ______
Will you keep the NBRF informed of any moves, illnesses,
escapes, or death of any Borzoi entrusted to your
care? YES
______ NO ______
My signature below means all information listed on this questionnaire is correct as I know it now.
______________________________________________________
________________________
(Signature)
(Date)
Please return this form to your local rescue contact or mail to:
Carol Backers, Director,
NBRF
7765 Kellogg Rd. NW
Alden, MI 49612
Toll-free:
1.888.264.8898
Home:
231.331.4434
Email: cbackers@torchlake.com