re : Great Pyrenees / Lab mix puppies 3.

5 Months This litter of three came from a crowded shelter in West Virginia. These pups are very sweet and friendly. They are very playful and love to play with other dogs. HAMPSHIRE COUNTY PET ADOPTION PROGRAM (HCPAP) DOG APPLICATION FOR ADOPTION

HAMPSHIRE COUNTY PET ADOPTION PROGRAM (HCPAP) DOG APPLICATION FOR ADOPTION

Please remember that adopting an animal is a SERIOUS commitment. Your new companion may take days, weeks or even months to settle into their new environment. Your commitment will require tons of attention and love. YOU are responsible for their health care cost. Sadly, too many animals are adopted and returned simply because folks did not think through the adoption carefully enough. Our mission and responsibility at HCPAP is to place the animals we rescue into an environment compatible with their needs and to ensure their adoption is in the best interest of both the animal and the adopter. As such, please initial this paragraph and answer the following questions.

Initials__CMF_________________

Date __5/15/2012_____________

NAME Maurice Franck

&

Susan Birch-Franck

STREET ADDRESS 28 N Lombardy St CITY,STATE,ZIP Richmond , Va. 23220

(You must provide at least 2 valid phone numbers)

HOME PHONE 804-355-3513 CELL PHONE 804-240-4540 WORK PHONE 804-240-4540 EMAIL ADDRESS mauricefranck@aol.com AGE OF APPLICANT 52 and my wife 60

If you have not resided at the given address for at least 2 years, please provide previous address. n/a STREET ADDRESS

CITY, STATE, ZIP

Can you present current identification with your current address listed? yes ADDRESS LISTED: I work from my home , my employer's address is Brightwood, Va EMPLOYER: Juice , Fine Wine Management HOW LONG HAVE YOU WORKED THERE? with this wine distributor since Aug 2011 NUMBER OF PERSONS IN HOUSEHOLD ADULTS two TEENS n/a

CHILDREN (over 2 years) n/a INFANTS (2 years or less) n/a Have you ever adopted from HCPAP? no If yes, when?

Do you still have the pet?

Was the pet altered? my last two dogs were adopted, and I had both neutered & spayed Please list all the companion animals you have been guardian to in the last 5 years. Maggie , Bernese Mtn Dog passed from cancer Apr 2012 Henry , Great Pyrenees/Shar Pei mix passed from heart disease 2003 Mollie , Terrier ? Water Dog ? passed of old age 2004-2005 Paddington , Great Pyrenees passed of old age 1994-1995

What type of food do you feed: we have used mostly premium dog food or Purina One depending on the dog's needs Amount of food: as recommended , with Maggie aprox 3 cups twice daily How often do you feed: twice daily What Veterinarian(s) care for and vaccinate your pet(s)?

NAME: Bob Magnus DVM VET CLINIC: www.therichmondhousecallvet.com

PHONE NUMBER: 804-937-9663

Why do you wish to adopt a companion at this time? (Please explain). I/we benefit from the companionship, the social interaction with our dog, the unconditional love of course giving a home to a puppy in need, realizing that my fondness for larger breed dogs in particular the herd protection working breeds is important as well

Have you ever done any of the following: no I have not , all of my pets have been fixed and have not had puppies to give away Given away an animal? no Lost or stolen an animal? no certainly not Turned an animal into a shelter or rescue group? I have helped bring in a stray that was taken to a local no kill rescue group , but not an animal of my own , no

If you answered yes to any of the questions above, please explain: n/a

Do you own or rent your home? own a free standing house What type of housing do you live in? (please circle)

House Condo/Town home Mobile home Apartment

If you rent, please give the name and telephone number of the landlord or rental agent so we may verify that pet guardianship is permitted. n/a NAME:

RENTAL AGENCY:

PHONE:

Does anyone in your household have allergies? minor - pollen , mold

Is someone home during the day? yes , I am in & out through the day and my wife is home she works 3 nights each week , at which time I am home Who? above How many hours will your new companion be alone? 1 - 2 at a time, rarely as long as 3 hours

Where will your new companion be kept during..

The day: crated while a puppy , and until mature and trained At night: crated while a puppy, and at the foot of our bed when mature , occasionally on the bed When you travel: we have a dog walker/sitter Tish Ward [ Helping Hands In The Fan ] who has always kept our dog in her home, with her and supervised, when the dog was not travelling with us and I plan on continuing to use her services

Do you have a fenced yard? yes

If NO, are you willing to fence? n/a

If YES, what type of fence and height? wood slat fence 6 ft high , two gates between the yard and the street

Do you currently have a plan to have a doggy door? do not

How much time to you realistically have each day to exercise and play with your new companion? 4 - 5 hours and more

Because it is very stressful for an animal to go from home to home, we hope to place each one in a caring home for the rest of his/her life, which could take up to 18 years or even more. Are you prepared to make this commitment? Completely !

What will happen to the dog if you have to move? the dog will move with me

What if you move to a place that does not allow pets? will not do that !

Your new pet may take several weeks to fully adjust to you and your home. How would you ease the adjustment? with patience , consistence, doting attention, positive reinforcement, planning, the assistance of a professional trainer if needed ( we did with Maggie to overcome her separation anxiety at 6 - 9 months )

Are your pets current on vaccinations? yes If you have cats, have they been exposed to dogs? yes , they were very good friends Are your cats de clawed? no If you answered YES, to the previous question, then why?

What kind of dog behavior do you find unacceptable? nipping , aggressiveness including food aggression, jumping, scratching, inappropriate chewing,

How would you handle these kinds of behavior? with positive reinforcement, patience, consistence, substituting good chewing objects, consistence and continued positive reinforcement With herd protection breeds, the word no is a scathing remark and they truly desire to please even while being stubborn and independent Do you believe in spaying and neutering? absolutely If you answered NO, please explain:

How much do you estimate it will cost per year to vaccinate, feed, and properly care for your new companion? averaging to $ 80 - 120 per month overall

What would cause you to return this dog to HCPAP? a genetic predisposition toward violently aggressive behavior / becoming a liability

Please provide 2 references. (Please do not include relatives or your veterinarian)

NAME: Lois Love PHONE: 804-355-2622

NAME: Mike Porch PHONE: 804-355-6974 Completion of this application form does not guarantee that HCPAP will place one of our rescues in

your care. Completion of this application authorizes HCPAP and/or a representative of HCPAP to verify any and all information contained herein, including verification of medical records or any present or prior pets in your care. All adoptions are at the sole discretion of Hampshire County Pet Adoption Program (HCPAP). By signing this application, I certify that all information is true and any false information may void this application. I also certify that this animal will reside with me at the given address in this application.

C . Maurice Franck _____________________________________________

May 15, 2012 _______________

APPLICANT and SOLE GUARDIAN of Animal to be Adopted

Date