Your Name:__________________________________________ Phone:_______________________

Address:______________________________________________________________________

You have expressed an interest in acquiring a Newfoundland dog which will be placed by the Genesee Region Newfoundland Club (GRNC) Rescue Committee according to the conditions set forth in the Criteria for Newf Placement. Please answer the following questions and return this application form to:

Carla Kinney
437 Kelsey Lane
Erieville, NY 13061
315-662-3819
e-mail ckinney@twcny.rr.com

1. Why do you want a Newfoundland dog?

What place will this dog have in your family’s lifestyle?

Who will have primary care, training, and grooming of this dog?

2. Do you currently have a fenced yard? YES or NO (If no, are you willing to fence an area for the dog’s safety and security?) YES or NO

3. Have you ever owned a Newfoundland or any other large breed of dog? YES or NO

4. Do you currently have another dog(s)? (If yes, what breed, sex, neutered/spayed?)

5. How many people live in your household? ______ Children and their ages?

6. Do you have other pets? What kind and how many?_______________________________________

7. Do you prefer a male or female? (choose one of the following)          MALE      FEMALE     No Preference

I certify that I have read and understand the Criteria for Newf Placement and agree to the conditions for placement. I further understand that any misrepresentation on my part will be sufficient grounds for refusal of this application.

Signature:___________________________________________________

Date:_____________________

Your application will place you on the “active” list for consideration when a Newf becomes available for adoption.