Application to Adopt A Keeshond
What dog are you interested in adopting?___________________
Today’s Date:_________________
Name:____________________________________________________
Address:___________________________________________________
City:_____________________________State:____ZIP:______
E-mail address: ______________________________________________
Home Phone:___________________ Work Phone:_____________________
I Work_______ Employer_____________________
Attend School_______________________
Other:_____________________________________________________
I Own:______ Rent______ Apt______ Condo______ House______
Use as much space as needed for all fill-in answers.
Who will be responsible for:
Feeding__________________________________________________________
Exercise_________________________________________________________
Vet Care_________________________________________________________
Training_________________________________________________________
Pets I (we) have owned:
DOGS :Breed________________Name_______________Sex_____Altered_Y/N
Breed________________Name_______________Sex_____ Altered_Y/N
Breed________________Name_______________Sex_____ Altered_Y/N
What happened to your last dog?________________________________
Are all dogs are current on shots? Yes or No (circle one)
On all dogs on heartworm preventative and/or checked annually? Yes or No (circle one)
CATS: Breed________________Name_______________Sex_____ Altered_Y/N
Breed________________Name_______________Sex_____ Altered_Y/N
Breed________________Name_______________Sex_____ Altered_Y/N
Are all cats current on all required shots and annual checkups? Yes or No (circle one)
Other pets I (we) have owned: (Please specify)
_______________________________________________________________
_______________________________________________________________
Veterinarian used in the past five years:
Name:_________________________________________
Address: ________________________________________________________ Phone:___________________________________________________________
We will ask this vet for a reference.
Please answer all the questions below. There are no "right" or "wrong" answers and there are no "trick" questions.
I want to adopt a rescue Keeshond because:
_____________________________________________________________
______________________________________________________________
Why do you want a Keeshond?______________________________________
Who will have ownership of this dog and what is the relationship to the applicant?___________________________________________________
Who lives in your household? Please provide names and ages of ALL occupants (including pets).
_________________________________________________________
_________________________________________________________
Will the dog be kept primarily indoors or outdoors? (circle answer)
How will the dog receive exercise?
Fenced yard? Yes or No (circle one)
Daily walks? Yes or No (circle one)
Dog play areas? Yes or No (circle one)
Other:_________________________________________________
When you are away (vacations, business travel, etc.) what will happen to your dog?
Travel with you on trips? Yes or No (circle one)
Kennel? Yes or No (circle one)
Dog sitter? Yes or No (circle one)
Other:_________________________________________________
In what dog activities will the dog participate? (Examples: obedience, agility etc.) ____________________________________________________________
Are you willing to take a dog for regular veterinarian visits and keep current on appropriate vaccinations? Yes or No (circle one)
Do you know to care for a dog's coat and trim its nails? Yes or No (circle one)
Are you award that a Keeshond has a heavy coat, sheds seasonally, is relatively active for its size, may bark to protect "his territory" and may dig holes? Yes or No (circle one)
If you move in the future, what will happen to your pets?
______________________________________________
Estimate the yearly expenses for a dog (food, vet license)______________________
Do any household members have allergies? Yes or No (circle one) If Yes, indicate to what are they allergic to? ______________________________________________________
My Keeshond will be alone (w/o humans) :______ hours a day _______ days of the week
My Keeshond will not be permitted in certain parts of the house? Yes or No (circle one)
My Keeshond will be allowed on furniture? Yes or No (circle one)
I am familiar with the use of crates: Yes or No (circle one)
I am willing to use a crate, if necessary: Yes or No (circle one)
I am interested in doing obedience work with my Keeshond: Yes or No (circle one)
We require a home check by a current Keeshond Rescue member before all placements. Please initial here:________to show that you have read this requirement and agree to allow a home check and reasonable follow-up visits.
Provide three personal references who can attest to your interest, interaction, feelings about animals in general and dogs in particular:
1) Name: _____________________________Relationship: ________________
Phone: _______________ Address: __________________________________
City:____________________________ State: __________ Zip: __________
2) Name: _____________________________Relationship: ________________
Phone: _______________ Address: __________________________________
City:____________________________ State: __________ Zip: __________
3) Name: _____________________________Relationship: ________________
Phone: _______________ Address: __________________________________
City:____________________________ State: __________ Zip: __________
I UNDERSTAND THERE IS A NONREFUNDABLE MONETARY DONATION REQUIRED AT TIME OF ADOPTION: (write in Yes or No and initial) ________
I understand and agree that if I am, at any time in the future, unable to care for my adopted dog, that dog is to be returned to the person or persons from whom it was obtained. In the event that that is impossible, the dog MUST be returned to Keeshond Rescue. The dog may not be abandoned, given or sold to anyone else, or turned over to any shelter, pound, humane society or similar organization. Please initial to indicate your acknowledgement and agreement with this clause. ______
By signing below, I certify the information provided by me is true to the best of my knowledge and I recognize that any misrepresentation of that information will result in my losing the privilege of adopting a rescue Keeshond. I understand that Keeshond Rescue has the right to deny my request to adopt a Keeshond, and I authorize checking of all information provided in this application.
Signature:____________________________________Date:___________