Northeast Ohio Shetland Sheepdog Inc

Adoption application

Name:

Address:

City:                                                                 State:                            Zip Code:

Phone:  Home (      )                                         Work  (      )

Occupation/Employer:

May we call you at work?

Email Address:

Do you check Email every day?

How long have you lived at your current address: ______________If less than two years, then list your previous address:

______________________________________________________________________

Type of residence:  House __________ Apartment __________ Mobile home________ Condo __________

Do you:  Own _____ Rent _____ If renting, do you have permission to have pets?

____________________

Does the place you live have any restrictions as to the size, weight, or number of dogs you are allowed to own?  ___________

Landlord’s name: _____________________ Phone (        ) __________________

Number of children in home: ___________ Ages: _________________________

Are there others besides your immediate family residing in your home? __________

If Yes, who? __________________________________________________

Does your home have a yard? _________ Is the yard entirely fenced? _____________

What type of fence and how tall is it? __________________________If you do not have

a fence, how do you plan to confine the sheltie to your property?

_______________________________________________________

Have you had pets in the last five years? _________________

What kind? __________________________

What happened to those pets? ___________________________________________

Were they spay/neutered: __________ If not, why? __________________________

Do you intend to keep the sheltie indoors or outdoors?  Please elaborate!

____________________________________________________________________

____________________________________________________________________

Where will your dog be kept while you are away from home (Crate, Baby gated in room, Full run of house, outside in fenced area, etc.)

_________________________________________________________________

What is the longest period or time your dog may be left alone?

_________________________________________________________

Who will care for your pet(s) if you go away on vacation?

_________________________________________________________

Will your dog be permitted on your furniture? _________________

In your bed? _____________________

Will you take your new dog to obedience class if needed? _______________

List any reason(s) that would cause you to “give up” your Sheltie: (Divorce, Move, Baby, Allergies, etc.) ________________________________________________________

____________________________________________________________________

Since most of these dogs have unknown medical backgrounds, are you willing and prepared to provide any needed medical treatment? ___________________

Would cost be a factor? ______________________

Current veterinarian’s name

_________________________________________________________________

Address: __________________________________________________

City: ____________________________ State: ______________ Zip: ____________

Phone: (          )____________________

How long have you been a client? ___________________

Do you have a sex preference for a Sheltie?    Male: __________     Female: __________

No preference: ____________

Do you have a color preference? _____________

If yes, what color? ________________________________

What is the oldest age Sheltie you would consider? _____________ Would you consider a “special needs” Sheltie?  (Deaf, Blind, Behavioral problems, Medical issues, etc.)

_________________________________________________________________

Why do you want a Sheltie? ___________________________________________

Are you willing to allow a rescue representative to visit your home by appointment before and after the adoption? _______________ If not, please explain why:

_________________________________________________________________

PLEASE READ AND INITIAL EACH STATEMENT BELOW

I certify that the information I have provided on this form is true and correct

____________

I am financially able to provide the Sheltie with the proper food and veterinary care, which may be costly.  (National average expenses for a dog is estimated to be $600.00 or more annually)

_____________

I understand that any false statements constitute grounds for confiscation/surrender of the Sheltie back to the rescue upon demand.

_____________

I agree that if the adoption is unsuccessful that I will contact the rescue immediately and return the Sheltie to them.

______________

Under no circumstances will I place this Sheltie with another person, organization, relative, or anyone else other than the rescue or their authorized representative.

______________

I further understand that the rescue may demand return of this Sheltie for any violation of the terms of the adoption contract.

______________

We reserve the right to refuse any application

Adoption donations:

$175     Adult Sheltie

$100     Senior, Special needs, etc.   May be adjusted at discretion of NEOSSR representative

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