Parson Russell Terrier Association of America
Parson Russell Terrier Rescue
Sue Porter
135 Honey Hill Rd. 
East Haddam, CT 06423Phone: (860) 526-3918
Email: dlporter01@snet.net
Rescue Program
Adoption Application Form
135 Honey Hill Rd. East Haddam, CT 06423 Email: dlporter01@snet.net
Rescue Program
Our dedicated volunteers carefully evaluate dogs in the PRTAA Rescue Program in foster care, and we ask many questions of prospective adopters so that we can make just the right match between dogs and adopter. The information you supply will help us do that. You must be 18 years or older to adopt from the Rescue Program. Thank you in advance for your interest in helping a Parson Russell Terrier in need.
Personal Information Required
Please print
Name:_______________________________________________________________________
Address:_____________________________________________________________________
City:__________________________ State:____________________ Zip:______________
Home phone:_________________________ Work phone: _________________________
(Note: Applications without home phone number will be discarded)
Best time to contact AM _____ PM _____
Email Address:_______________________________________________
Referred by:____________________________ Phone number:____________________________
Home life Required
Type of dwelling? House_____ Condo/Apartment______ Farm________
Years in Residence? Less then a year_____ 1-5 years_____ more than 5_____
If you rent, do you have permission from your landlord to have a dog? _____
Name and telephone number of landlord ____________________________________________
_____________________________________________________________________________
Do you have a fenced in dog area? ______
If no, how will you contain your dog, please explain? ____________________________________
_____________________________________________________________________________
Fencing on your property is:
chainlink__ wood__ electronic__ strung wire__ no fencing__ other__
Height of fencing: under 4 feet__ 4 to 5 feet__ 5 to 8 feet__ buried wire__
Footing surface for dog: grass__ concrete__ gravel__ dirt__ sidewalks__
Length and width of dog area in feet or acres ____________________
Do you have dog doors? ____
Do the dog doors open directly to the dog's area? ____
Do you have a swimming pool? ____
Does it open to the dog's area? ____
Local Laws
There is a leash law in my community? _____
Is there a license law in my community? _____
Family Environment
List the members of your household including ages of children and frequent visitors: ____________
___________________________________________________________________________
___________________________________________________________________________
Do you expect to have more children? _____
If yes, explain how you will introduce the dog to the new child. _________________________
____________________________________________________________________________
Do all family members want a Parson Russell Terrier? _____ If not, Why_______________
____________________________________________________________________________
Does anyone in your household have allergies to dogs that you are aware of? _____________
____________________________________________________________________________
Parson Russell Terrier Awareness
Why do you want a Parson Russell Terrier? _______________________________
_____________________________________________________________________________
_____________________________________________________________________________
Is this your first Parson Russell Terrier? _____
What do you know about Parson Russell Terriers? What qualities appeal to you?________________
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What kind of temperament would best suit your household?
Energetic, always on the go___ Sweet and cuddly___
Loves to walk, run or hike___ Couch Potato 80% of the time___
Protector of the house-barks loud____ Patient and tolerant of children___
Devil dog-needs constant watching or will chew your house down___
Primary Caregiver
Name the person who is the primary care giver for this dog: ____________________________
How many hours will the dog be left alone in a given 24 hours period? ______________
Where will the dog be kept when you are at work or out of the house? ___________________
Where will your dog sleep? ______________________________
What activities would you like to share with your dog? ________________________
_____________________________________________________________________________
What will you do if your dog gets lost? ________________________________
_____________________________________________________________________________
Have you ever obedience trained a dog? _____
Will you obedience train the dog? _____
Formally with a trainer? _____
Group obedience class like, Pet Smart? _____
Informally yourself? _____
No training will be given _____
Will you use a dog crate? _____
Have you ever trained a dog to a crate? _____
If applicable, will household members support and care for the dog? _____
How will your dog be taken care of when you are away on business or out of town?
Cared for by family member_____ Pet sitter_____ Kennel______
Kennel, groomer or vet_____ Neighbor_____ leave with a relative or friend_____
If the dog is a puppy or less than 9 months old and you work full time, will you or someone walk your dog at noon?_____
If no, how will you house break the puppy, explain. ___________________________
_____________________________________________________________________________
Dog Preference
Are you interested in: Male_____ Female_____ No preference_____
Are you interested in a Puppy_____ Young adult_____ Older animal_____ Special needs dog_____
Current Pet Count
Do you currently own or live with any other animals?_____
If yes, what type, spade/neutered and ages of animals list what other animals live in your home? _____________
___________________________________________________________________________________
Are your animals up to date on their shots and vaccines?_____
What brand of Heartworm medication do you use? _____________________________________
What brand of flea and tick preventive do you use? _________________________________
What brand of dog food do you use? _________________________________________________
Have you ever returned a dog to its breeder?_____
If yes, what were the circumstances? ______________________________________________
____________________________________________________________________________________
Have you ever given a dog away?_____
If yes, what were the circumstances? ____________________________________________
______________________________________________________________________________________
Have you ever taken a pet to a pound or shelter? _____
If yes what was the circumstance? __________________________
______________________________________________________________________________________
Under what circumstances would you give up a dog? ________________________
______________________________________________________________________________________
Describe previous dogs you have owned how long they lived what ultimately happened to them:
__________________________________________________________________________________________
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Personal References
List 2 personal references that do not live in your home, your Veterinarian and a trainer that you have worked with.
Name _____________________________________ Phone number ______________________
Best time to call AM_____ PM_____
Name _____________________________________ Phone number ______________________
Best time to call AM_____ PM_____
Veterinarian name ___________________________ Phone number ______________________
How long have you used this Vet? ____
Are you willing to have a member of the PRTAA Rescue Program visit your home prior to adoption or
following an adoption to ensure the safe keeping of the dog? Yes_____ No_____
The PRTAA Rescue reserves the right to decline adoption or reclaim any dog in our judgment appears
abused, unkept or unsafe at anytime.
By submitting this form, I certify that I am over the age of 18 years and that the information provided on this form is accurate. I am physically, emotionally and financially able to care for and understand the proper food, veterinarian care and training of a Parson Russell Terrier.
Signature: ______________________________________________Date: ____________________
Please return form to the closes PRTAA Rescue Respective with a $25.00 application fee. This fee will be applied toward the adoption fee of the dog. The application fee of a PRTAA Rescue dog is $200.00. When you adopt a dog, he/she will come with crate, bowls, collar, leash, all shots and either spade/neutered, and tattooed or micro chipped. The PRTAA will be hold the tattoo or micro chips in the PRTAA club's name and the adopter will be the second contact.
Susan Porter
135 Honey Hill Road
East Haddam, CT 06423
(860) 526-3918
Revised December 2003