First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Work Phone
x

Cell Phone*

Which Sheltie are you interested in adopting?
Choose an animal: Baxter Blue

What is your date of birth?*

Occupation*

Spouse's Name

Spouse's DOB

Spouse's Occupation

Describe why you would like to adopt a dog and why have you chosen a sheltie?*

Have you ever owned a Sheltie before?*

Please list Past and Present Pets and what happened to them*

Are/Were your pets spayed or neutered?*

Are/Were your previous pets current on their vaccinations?*

Are/Were your previous pets on Flea and Heartworm prevention?*

What Brand of Heartworm and Flea Prevention do you use?*

For what purpose do you want this dog?*

Are there children living in your home?*

If there are children in your home, how many and what are their ages?

What type of home do you live in?*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Do you own or rent your home?*

If you rent, have you received the approval of your landlord to have an animal
Choose one: Yes No

If you rent, please enter your landlord's name and phone number

We require our shelties to have a fenced yard, is your yard fenced?

What type of fence*
Choose one: Privacy Chain Link Invisible

What is the height of the fence*

Is someone home during the day?*

Number of hours a day no one will be home?*

Where will your sheltie be kept when you are not home?*

How will you exercise your dog?*

Where will your Sheltie sleep at night?*

Are other members of your household aware that you are considering adopting a dog?

Is anyone in your household allergic to dogs?*

Are you prepared to accept the financial responsibility of caring for an animal, including veterinary care, good quality food, grooming, licensing etc?*
Choose one: Yes No

What will you do with the dog if you move?*

Are you familiar with the local animal control regulations?*

What circumstances, in your mind, justify getting rid of a dog?*

Have you applied with any other rescue
Choose all that apply: Yes No

Are you willing to have a rescue volunteer visit your home by appointment?*

Please list the names and phone numbers of all veterinarians used in the last 7 years.*

May we call your vet?*

Do you, or others in your household have any concerns about adopting a Sheltie? If so, what are your concerns?*

I understand that by submitting this form, I am attesting to the truthfulness of my answers. I understand that false information on this form will be grounds to disallow adoption of a rescue Sheltie.*
Choose one: Yes No

BELOW FOR OFFICIAL USE ONLY

Vet Reference checked by

House/Fence check by

Date