I/we hereby submit this information to TIBETAN SPANIEL CLUB OF AMERICA RESCUE in partnership with the TSCA RESCUE AND HEALTH TRUST (hereafter the "Rescue") with the intention of adopting a Tibetan Spaniel from the Rescue. I/We understand that, when selecting adopters, the Rescue is motivated solely by concern for and love of the Tibetan Spaniel breed, that they are acting as good Samaritans and that no TSCA member or Trustee profits from the adoption. I/We:
1. Do not own or have any interest in a pet shop or boarding kennel and that I/we are not engaged in buying dogs for resale.
2. Have never been convicted of cruelty to animals.
3. Have not been disciplined nor are under suspension by the American Kennel Club, Tibetan Spaniel Club of America, or any other purebred dog association or organization.