Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone *

(###)

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Home Phone

(###)

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####

Work Phone

(###)

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Do you have children living at home? *

Yes

No

Activity level at home? *

Very Active

Active

Quiet

Very Quiet

Non-Active

What is your definition of a dog? *

A pet that the family hangs out with when they have time to.

A pet that plays and stays outside all day by himself.

A pet that hangs out with the family, wherever the family is.

Where is the ideal place for a dog to sleep? *

In the garage

Outside in a nice dog house

On a dog bed in a bedroom

On the bed

What would you do with your dog if you have to move? *

Give the dog back to the rescue so they can find another good home for him.

Find another home for him with a friend or family member.

Find a home where he can live with me.

Reference #1 Phone Number *

(###)

###

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Reference #2 Phone Number *

(###)

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Reference #3 Phone Number *

(###)

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Do you have any cats? *

Yes

No

Do you have any dogs? *

Yes

No

Have you had dogs in the past? *

Yes

No

Do you have a Veterinarian? *

Yes

No

Have you ever had a German Shepherd before? *

Yes

No

Have you ever given away a pet? *

Yes

No

Do you own or rent your home? *

Own

Rent

What kind of home do you have? *

House

Condo

Townhouse

Apartment

Other

Do you have a yard? *

Yes

No

Is the yard fenced in? *

Yes

No

I do not have a yard

Do you have locks on all gates? *

Yes

No

Do you have a pool? *

Yes

No

Is your pool fenced in? *

Yes

No

I do not have a pool

Do you have a dog door in your house? *

Yes

No

Where is the dog door located? *

Kitchen

Laundry Room

Garage

Other

I do not have a dog door in my house

Will the dog be alone during the day? *

Yes

No

Date Signed *

MM

DD

YYYY