German
Shepherd Dog Rescue of Utah, Inc.
ADOPTION APPLICATION
This completed questionnaire will help us pick the very
best dog for you, your family and your lifestyle. It is very important that we find the correct home for
every rescued GSD in our program.
Completing this questionnaire will tell us whether you would do better
with an active or quiet, soft or dominant, independent or submissive dog.
Please fill out ALL of the information requested. An incomplete application will be
discarded. If a question does not
apply, put n/a. (Use as many sheets of
paper as necessary).
1. Name:
___________________________________________________Date: ___________________
2. Address: ________________________________
City:_______________State: ____
ZIP: ___________
2a. email
address: ___________________________________ 2b) Drivers License #:
_____________________
3. How long at
current address:
_______________________
4. Telephone
number(s): Home: (_____)
________________ Cell: (_____)
_________________
Work: (_____)
________________
5. With whom
are you employed?
_______________________________________________
Spouse
Name/Employer: _____________________________________________________
6. Occupation(s): ___________________________________________________________
7. Number and
ages of children living in household:
_________________________________
8. What type of
area do you live in? City ___ Suburb ___ Rural ___
9. What type of
housing? Apt. ___ Condo ___ Duplex ___ House ___ Other ___
10. Do you rent
or own your home?
______________________________________________
If rental,
landlords name, address, phone: ________________________________________
11. If you rent
or lease, do you have permission from your landlord:
to
own a dog? Yes ___ No ___
to
own a GSD? Yes ___ No ___
12. a) What other dogs have you previously
owned? ________________________________
_____________________________________________________________________
b) What happened to them? (Please list) _______________________________________
_____________________________________________________________________
c)
What dogs do you currently
own (breed/age): _________________________________
______________________________________________________________________
13. What other
types of animals live in your home?
_____________________________________
___________________________________________________________________________
14. What do you
know about the GSD as a breed?
__________________________________
___________________________________________________________________________
15. How did you
hear about our GSDs, and who referred you to us? _____________________
___________________________________________________________________________
16. Tell us about
the type of dog you are looking for:
Male ___ Female ___
Don’t Care ___
Reason for
gender choice: ______________________________________________________
Age (check
as many as may apply): Baby
_______ Under 6 months _____ Under 1
year ______
1
to 3 years ______ Adult _______ Senior
(over 8 years) ______ Don’t Care ______
Are you
willing to adopt a dog that is not housebroken? Yes _____ No ______
Are you
willing to adopt a dog that jumps fences? Yes _____ No ______
Are you
willing to adopt a dog that has minor medical problems? Yes ____ No _____
Are you
willing to adopt a dog that may need to be an only dog? Yes ____ No _____
Are you
willing to adopt a dog that is not good with cats? Yes ____ No _____
17. a) Do you have a fenced yard? Yes ___ No
___ Height of fence __________
b) Describe your fence (type, construction,
etc)
___________________________________
c) If you don’t have a fence, where and
how will the dog be exercised and be allowed to
eliminate?
______________________________________________________________
18. What member
of the family will be taking the MAJOR responsibility of caring for this GSD?
____________________________________________________________________________
19. What are your
plans and goals for this dog?
_________________________________________
____________________________________________________________________________
20. a) Have you ever trained a dog in obedience
classes? Yes ___ No ___
b) Will you take your GSD to an obedience
class? Yes ___ No ___
21. Where will the dog spend its
time when you are at work?__________________________________________
_______________________________________________________________________________________
Where will
the dog spend its time when you are at home?
_________________________________________
_______________________________________________________________________________________
22. Where EXACTLY
will the dog sleep at night?_______________________________________
____________________________________________________________________________
____________________________________________________________________________
23. Do you
believe in dog crates? Yes ___ No ___
Would you
be willing to use one to housetrain your new dog? ___________________________
____________________________________________________________________________
24. What are the
major activities, hobbies, or exercises you and your family most participate
in?
____________________________________________________________________________
25. If you move,
what will you do with your dog? _______________________________________
____________________________________________________________________________
____________________________________________________________________________
26. When you go
on vacation, where will your dog go and who will care for it? _________________
____________________________________________________________________________
27. Who is the
veterinarian that you have or would use?
Please provide all information:
Name: ______________________________________
Address:
_______________________________________________
Phone: ________________________
28. How will your
dog travel to the Vet or other places? (In a car, van, back of a pickup truck,
etc)
____________________________________________________________________________
29. Do you mind
if we call your Vet and ask how you take care of your animals? Yes ___
No ___
If yes, why?
__________________________________________________________________
30. Are you
willing to allow a NU-GSD Rescue representative to periodically visit your
home?
Yes ____
No ____ If no, why?
________________________________________________
31. Please list
the names, addresses, and phone numbers of two (2) personal references (not
related)
that you
have known for at least two (2) years:
1. ____________________________________________________
____________________________________________________
2. ____________________________________________________
____________________________________________________
32. Please tell
us a little about yourself and why you feel you could provide a good home for a
rescue
dog:
________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________
(signature of applicant, not required if emailing application)
WE RESERVE THE RIGHT TO REFUSE ANY APPLICANT
Complete and return to:
Nancy Roberts, USU Box 1295, Logan, Utah 84322-0199