General Information:
Today's Date:	-- mm/dd/yy
First Name
Last Name
Middle Initial
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Home Phone
Work Phone
FAX
E-mail

Employment information:
Employer
How Long?
Phone Number
Employer
How Long?
Phone Number

Please list two references:
First Name
Last Name
Middle Initial
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
First Name
Last Name
Middle Initial
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code

Do you have a preference as to the sex of your new dog?

Choose Sex Preference Male Female No Preference

Would you consider a German Shepherd Mix?

German Shepherd Mix? Yes No Maybe

Do you have a preference as to the color of your new German Shepherd?

Choose Color Preference Black/Tan Black/Silver Solid Black White Sable No Preference

What is the age range you would like to adopt?

If you have a small children (under 7) we cannot adopt a puppy or dog of unknown background to you.

Choose Age Range Puppy Only (under 6 months) Young Adult (6 mths-3 yrs) Adult (3-6 yrs) Senior (7 yrs-up) Any Age

Whom is this dog for?:

What characteristics do you expect in your new dog?

Active  Playful  Independent  Protective  Dominant  Shy-Docile  Calm  Good with Kids  Intelligent  Loving  Aggressive  Submissive  Outgoing-Friendly  Good with other pets  Other-Please Explain:

We recommend that to facilitate the bonding process, each new dog should attend some introductory "Obedience Training" classes. Would a formal obedience training program be something that you as a new owner would be interested in??

Yes No   If No, Please Explain:

Regarding your current residence, do you?

Choose your residence Own a Single home Rent a Single home Own a Condo-Townhouse Rent/Lease a Condo-Townhouse Other

Do you have a fenced in yard where you reside for exercising your new dog?

Yes No If No, do you have access to a fenced area? Yes No   Explain:

If you have a pool is it fenced in?

Yes No

Have you checked the yard for dangerous articles, plants or anything the dog could use to climb the fence?

Yes No

Are you aware of any distractions outside your yard that could plague the dog (such as neighbors dog, loose dogs on the street, mischievous children)?

Yes No

Yes No

Approximately how many hours each day do you anticipate that your new dog will be alone?

3 hrs or Less 3 - 6 hrs 6 - 8 hrs 8 - 12 hrs More than 12 hrs If more than 12 hrs, please Explain:

If you have checked more than 6 hours or longer in the question above, what provisions will you make for the dog to relieve itself and get exercise during your absence?

Explain:

How many adults live in your home?

How many children live in your home?

Child Name: Age:   Sex: Child Name: Age:   Sex: Child Name: Age:   Sex: Child Name: Age:   Sex:

If you have children under the age of 7, we cannot adopt a puppy or dog with unknown background to you.

What other pets do you currently have?

Dogs name: Breed:   Age:   Sex:   Spay/Neuter? Yes  No Cats name: Breed:   Age:   Sex:   Spay/Neuter? Yes  No Dogs name: Breed:   Age:   Sex:   Spay/Neuter? Yes  No Cats name: Breed:   Age:   Sex:   Spay/Neuter? Yes  No Other pets please list (including reptiles and bird)

Have you owned a German Shepherd before? (for those wishing to adopt a Shepherd)

Yes No If Yes, Please provide us with a brief history about that dog(s). Name:   Sex:   Reason you no longer have:

Have you owned ANY other pets in the past 10 years other than those listed above?

Yes No Please explain what happened to all previously owned pets and the circumstances in which you no longer have them:

Do you currently have a veterinarian?  Also if you've recently changed veterinarians please fill out the "Previous Practice" below.

Yes No Practice Name:   Doctor's Name:  Phone Number with area code:  Street Address:  City/State/Zip:   Length of time you have been going to this Vet?  "Previous Practice" Practice Name:   Doctor's Name:  Phone Number with area code:  Street Address:  City/State/Zip:   Length of time you had been going to this Vet?

If you've not had a pet within the last year, please tell us who your veterinarian was for the previous pet?

Practice Name:   Phone Number:

If you currently own a dog, is your dog current on Heartworm medication?

Yes No

Are ALL your pets current on all vaccinations?

Yes No If No, please explain:

As part of the adoption process and before placing any dog, you will be asked to sign a contract in which you agree to certain conditions.  Such as allowing a GERMAN SHEPHERD RESCUE representative to visit your home before and after placement of the dog, and finally, surrender back to GERMAN SHEPHERD RESCUE of the dog if you violate the contract or are unable to keep the dog or any reason.

Are you willing to sign and be bound by, such a contract?

Yes No

How did you find out about our organization?

Choose one Please Shelter Newspaper Web Search Friend Other

Would you consider to volunteering for our organization?

Yes No If Yes, in which of the following areas? Foster Care  Transportation of animals  Computer Assistance Telephone Calling      Personal Interviewing of adopting candidates  Fundraising  Other

Thank you for taking the time to complete this application.  Your answers will permit us to more effectively match your needs with the dogs in our program. Please only hit the submit button once.