Adoption Application

Adoption Application

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Prior to completing the adoption application please read the adoption procedures on the Adopt/foster/surrender page.

*All information is required unless italicized in gray.

Contact Information

Last Name:

First Name:

Middle Initial:

Address 1:
Address 2:
City:	State:	Zip:

Home Phone:

Work Phone:

E-Mail:

Questionnaire

Please list all organizations to which you have applied to adopt a pet. Include Contact information for each.

1) Why do you want a Shetland Sheepdog?

2) Have you ever owned a Sheltie before?	Yes No
2b) Do you still have that dog?	Yes No

3) How many pets have you had in the last 10 years?

If more than 10, explain:

3b)What happened to those pets if no longer with you?

4) During the last ten years (see below):

a) Have you lost a pet (not through death)?

Yes No

b) Have you had one poisoned?

Yes No

c) Have you had an animal killed by a vehicle?

Yes No

d) Have you had an animal die due to disease?

Yes No

If yes, what did it die of?

5) For what purpose do you want this dog?

6) Do you have any other animals (list names, type, age, sex and whether they are neutered/spayed):

7) Please list everyone who lives in your household and their ages (including yourself):

8) Please indicate whether you live in a house, apartment, condo, or trailer:

If Other, Explain:

9) Do you rent or own?

If Other, Explain:

10) If you rent, do you have the landlord’s permission to keep a dog?

Yes No

If Yes:	Landlord's Name:
If Yes:	Phone Number:

11) Do you have a yard?

Yes No	If yes, is it fenced?	Yes No
	If yes, fencing type:

12) Do all family adults work?	Yes No
12b) Is someone home during the day?	Yes No	Please explain:

13) Do you intend to keep this dog primarily indoors or outdoors?

Where will it sleep?

14) Do you have a sex preference?

15) Do you have a color preference (if so, please list first and second choices)?

Yes No
Color Primary:		Color Secondary:

16) Would you consider an older dog?

Yes No

To what age?

17) What size Sheltie do you prefer?

* Hold the Control when selecting more than one.

18) Are other members of your household aware that you are considering adopting a pet?

Yes No

19) Are you prepared to assume the financial responsibilities of caring for an animal, including inoculations, heartworm preventative, veterinarian care, good quality food, licensing, etc?

Yes No

20) Are you planning to move in the near future?

Yes No

21) Is anyone in your house allergic to animals?

Yes No

22) Are you familiar with animal control regulations in your area?

Yes No

23) Is this Sheltie going to be a gift?

Yes No	For whom?
Do they know they are getting the gift?		Yes No

24) Do you understand that any rescue Sheltie that you may adopt through Peach State Sheltie Rescue, Inc. will be spayed/neutered?

Yes No

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

26) Are you willing to allow a Rescue representative member to visit your home by appointment?

Yes No

27) How did you hear about Peach State Sheltie Rescue, Inc.?

28) Do you accept that there will be an adoption fee for the adopted dog?

Yes No

29) Please provide your vet's name, address and telephone number. If you do not currently have need of a vet, please list one you have used in the past 5 years:

Agreement

I am in full agreement with the Peach State Sheltie Rescue, Inc. Terms of Adoption.
By sending this e-mail I am attesting to the truthfulness of my answers.
I understand that falsification of any of the above information will be grounds to disallow the adoption of a rescue Sheltie.

I Agree

Full Name:

Thank you for considering a dog from Peach State Sheltie Rescue, Inc. If you have any questions, or if we can be of assistance, please do not hesitate to contact us.

We reserve the right to refuse any applicant.

NOTE: If you are under 18 years of age, a parent or guardian must also sign this application.

If you have submitted an application and have not heard from someone in one week or if you are having technical difficulties with the application please call us at 678-494-0413. All volunteers with this rescue work full time and someone will return your call as soon as possible. Thank you for your patience.