Instructions: Please read this Application, fill in the blanks, sign it, and mail it to us at: Mit Liebe German Shepherd Dog Rescue, LTD, 2765 Longview Lane, Suamico, WI 54143. The information you provide in this Application and during our interview will help us find a good match for you.

Name: ______________________ Spouse/Partner/Roommate: __________________

Address: ____________________ City: ________________ State: ____ Zip: _____

Home Phone: _______________ Occupation: _______________ Hours: __________

Age: Over 21? 0 Yes 0 No

Please list three personal references and their relationship to you:

Name: ______________________ Relationship: ______________ Phone: _________

Address: _______________________________________________________________

Name: ______________________ Relationship: ______________ Phone: _________

Address: _______________________________________________________________

Name: ______________________ Relationship: ______________ Phone: _________

Address: _______________________________________________________________

Your Veterinarian: __________________ Address: ____________________________

Phone: ______________________

Please describe the kind of dog you are interested in adopting:

Age: _______ Sex: ________ Reason for sex preference? ______________________

Breed/mix: ________________ Size: ___________ Coloring: __________________

Temperament: ________________ Will it be a working dog? _____________________

Why do you want a dog? __________________________________________________

Can you commit to care for the dog for its whole life? ___________________________

Why do you like the breed/mix you are interested in? ____________________________

Have you owned this breed/mix before? ______________________________________

Sterilization: If the dog you want to adopt is not yet sterilized, you agree it must be sterilized either before or shortly after you adopt it.

Please provide the following information about your pets (if any), your children (if any), and your home:

Your Dogs:

How many dogs do you have? ________ Breed/mix _______________ Ages: ______

If none, have you owned any dogs in the last 10 years? ___________________________

What happened to them? ___________________________________________________

Were any bought from a breeder? ___________________ From a store? ____________

Adopted from a shelter? ____________________ inherited? ______________________

Found stray? ________________________ Other? _____________________________

Do your dogs have any physical problems? _______ Any behavior problems? _______

Any dominance problems? __________ Do they get along with other dogs? _________

Your children:

Do you have children? ______________________ Number _______ Ages _________

Have they had dogs? ____________ Was it successful? _________________________

Your cats:

How many cats do you have? ____ Ages? _____ Any behavior problems?___________

Do they get along with dogs? _______ Are they declawed? ______________________

Other pets:

Describe _______________________________________________________________

Your home:

Number of adults? _______ Do you own or rent? ________________ If you rent, do you have written permission from your landlord to have a dog? ____________________

Land lord name ___________________________ Landlord telephone _____________

Is it an 0 apartment, 0 duplex, 0 townhouse, 0 single house, 0 mobile home, 0 other?

Yard size? _____________________ Is it fenced? _____________ Height? ________

Any community restrictions on dogs? ________________________________________

How will your new dog spend its days? (Circle everything which applies)

Indoors Crated Basement Garage Porch Locked in a room

Fenced yard Loose unfenced Tied outside Dog house Kennel Run

How will your new dog spend its nights? (Circle everything which applies)

Indoors Your bedroom Kitchen Crated Basement Garage

Porch Locked in room Fenced yard Loose unfenced Tied outside

Dog house Kennel Run

Home visit: You agree to allow us to visit your home by appointment as part of our application process.

Application information: All of the information I/we provided in this application is true and correct. If any of the information changes, I/we will advise you promptly.