Northeast Ohio Shetland Sheepdog Rescue

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.)  ____________________________________________________________________________________

___________________________________________________________________________________

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:

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

• 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.)

• 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 circumstance will I place this Sheltie with another person, organization, relative, or anyone else other than the rescue or their authorized representative.  __________

• 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.