Please use the format below to enter your responses in a text editor or you can also print, complete and scan the application. EMail it to our application coordinator at
Northeast Ohio Shetland Sheepdog Rescue, Inc.
Adoption Application
Return to: wethreewests@gmail.com or Amy Jo West, 828 Dogwood Ln, Vermilion, OH 44089.
Name: _____________________________________________________________________________
Address: ___________________________________________________________________________
City: _______________________________ State: ______________ Zip Code: ________________
Phone: Home ( ) Work: ( ) Cell: ( )
Occupation/Employer: _________________________________ May we call you at work? ________
E-mail address: _____________________________________________
Do you check e-mail every day? __________
How long have you lived at your current address: ____________ If less than 2 years, please list your previous address: __________________________________________________________________________________
__________________________________________________________________________________
Type of Residence: House______ Apartment ______Condo______ Mobile Home_________
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 (w/Area Code): _________________________
# 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 this yard entirely fenced? ___________. What type of fence and how tall? _________________________. If you do not have a fence how do you plan to confine the Sheltie to your property? _________________________________________
Have you owned any pets in the last 5 years? ________
What kind: __________________________________________________________________________
What happened to those pets? __________________________________________________________
Were they spay/neutered: __________ If not, Why? _________________________________________
Do you intend to keep this 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 of 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 classes if needed? __________________________________
List any reason(s) that would cause you to “give up” your Sheltie: (Divorce, Move, Baby, Allergies, etc.) ____________________________________________________________________________________
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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 _____________________________ Phone (w/Area code ____________________
Address: ___________________________ City: _______________________ State: _____ Zip: _______
How long have you been a client? _________
I give permission for the veterinarian listed above to release information about myself and my pets to a NEOSSR representative via phone, email or correspondence. _______________________________________________________________________________
(Signature of owner)
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:
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I certify that the information I have provided on this form is true and correct. __________
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I am financially able to provide this Sheltie with the proper food and veterinary care. ________
National average expenses for a dog is estimated to be $600 or more annually.)
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I understand that any false statements constitute grounds for confiscation/surrender of the Sheltie back to the rescue upon demand. __________
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I agree that if the adoption is unsuccessful that I will contact the rescue immediately and return the Sheltie to them. __________
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Under no circumstance will I place this Sheltie with another person, organization, relative, or anyone else other than the rescue or their authorized representative. __________
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I further understand this 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 Donation: $250 Less than 1 year old, $200 Adult Sheltie, $100 Senior, Mixed Breed, Special Needs, etc., may be adjusted at discretion of NEOSSR representative.