Dog you're interested in:*

How did you hear about us?
Adopt-a-pet.comCraig's ListFacebookFriendFlyerGoogleNewspaperPetcoPetfinder.comPetsMartAnother RescueOther

If "other", please specify...

First Name

Last Name

Street

City

State
CA CaliforniaAL AlabamaAK AlaskaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDCDelawareFL FloridaGA GeorgiaHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaOH OhioOK OklahomaOR OregonPA PennsylvaniaRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming

Zip

How long have you lived in your current home?*

E-Mail:*

Home Phone:*

Work or Cell Phone:*

Best Number to call:*
HomeWork/Cell

Best time to call:*

Age:*

Employer:*

Work Phone:

Do You Own or Rent:*
OwnRent

Type of home:*
HouseApartmentTownhouseOther

Are dogs allowed in complex or HOA?
YesNo

Landlord name & phone number:

Is the yard fenced in?
YesNo

How tall is the fence around property?

Do you have locks on all gates?
YesNo

Do you have a pool?
YesNo

Is your pool fenced in?
YesNo

Do you have children?*
YesNo

Gender/Age Allergies?

Why do you want a rescue dog?*

Why do you want a German Shepherd?*

Where will the dog sleep?*

Will the dog be alone during the day? If so, how long and where will he/she be?*

How much time will the dog spend outside?

How often do you plan to exercise your dog, and how?*

Do you have a doggie door in your house?*
YesNo

Who will be mostly responsible for the dog?*

Who will provide for your pet in the event that you become ill or unable to care for him/her?*

Do you have other pets at home now?*
YesNo

(If yes, for each indicate breed, gender, age)

Pet #1

Pet #2

Pet #3

Pet #4

Are all your pets spayed or neutered?*
YesNo

If not, why?

Have you had a dog before?*
YesNo

If so, what breeds?

What happened to it?

Have you ever given away a pet before?*
YesNo

If yes, when did this happen? (Year)*

If so, why?

Name of your Veterinarian?

Phone No. of your Veterinarian?