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German Shepherd Rescue, Inc.

Adoption Questionnaire

Print out this form and fax to: 847-677-0562.

Your answers on this questionnaire will help us to match your needs with the German Shepherd Dogs in our program.

Name:
Address:


Daytime Phone:
Evening Phone:
Employer:
How Long:
Phone:
Employer:
How Long:
Phone:
Please List 2 References:
Name:
Phone:
Address:
Name:
Phone:
Address:
1. Please circle your preference Males Females No Preference
2. Do you have a color preference? (Circle all that apply)
Black/Tan Black/Silver All Black
Sable White No Preference
3. Do you have an age preference? (Circle all that apply)
Under 1 year 1 - 2 years 2 - 4 years
Over 4 years No Preference
4. Who is the German Shepherd for?

5. Have you owned a German Shepherd or any dog before? If YES, please give a brief history:

6. What is it about German Shepherds that interest you?

7. What other breeds have you considered?

8. Circle the 3 most important characteristics that you would like to see in your German Shepherd
Active Playful Independent Protective Dominant
Intelligent Loving Shy Aggressive Submissive
Other: (describe)
9. How do you plan to discipline your dog?

10. To facilitate the bonding process, we highly recommend that every new German Shepherd undergo some introductory obedience training. Would a formal obedience training program interest you as a new dog owner?(Circle one)
YES NO
11. Which of the following best describes your current residence? (Circle one)
Own House Rent/Lease House
Own Townhouse/Apartment Rent/Lease Townhouse or Apartment
Other: (describe)
NOTE: If you rent or lease your residence, proof of permission to own large dogs will be required befor the adoption is finalized
12. Do you have a fenced yard? (Circle one)
YES NO
If YES, please describe fence:
Type:  
Height:  
Number of Gates:  
    Can children easily open the gates?
13.  If your yard is NOT fenced, do you have a secure dog run?  (Circle one.)
YES NO
14.  What improvements, if necessary, will you make to secure your yard?
 
 
15.  If you do not have access to a fenced area at your home, would you like a rescue representative to provide recommendations on the safe confinement of your dog?   (Circle one.)

YES

NO  -   I have already made the following arrangements:
 
16.  Have you checked your yard for dangerous articles, plants or anything the dog could use to climb the fence?  (Circle one)

  YES

NO

   Would you like some assistance from a rescue representative?  (Circle one)

  YES

NO

   If you have a pool, is it fenced?  (Circle one)

YES

NO

17.  Do strangers (meter readers, etc.) require access to the area your dog will occupy?   (Circle one)

  YES

NO

 
18.  Are there any distractions outside the yard that may upset the dog?   (Neighbor's dog, loose dogs on street, neighborhood children, etc.)
19.  Approximately how many hours each day will your dog be alone?   (Circle one)
3 hours or less Between 3 and 6 hours
Between 6 and 12 hours Between 12 and 18 hours
Longer than 18 hours  
20.  How will your dog be confined when left home alone?
 
21.  Will the dog be kept primarily indoors or outdoors?
 
22.  Where will the dog sleep at night?
 
23.  What other animals currently live in your home?  (Please list ALL)
Type of pet Sex/Age How Long Owned? Where kept?
       
       
       
       
24.  How many other people currently live in your home?  (Please list ALL)
Name Relation to You Age
     
     
     
     
     
25.  Does anyone in your family have allergies to dogs?  (Circle one.)
YES NO

26. Who will have primary responsibility to care for the dog?

 


27.  Have you and your family discussed the pros and cons of owning a German Shepherd?  (Circle one)

YES NO

28.  Is everyone in your family enthusiastic about getting a German Shepherd?   (Circle one)

YES NO
29.  Do friends, relatives and children have access to your home, property and car without your supervision?
YES NO
30.  Are you willing to instruct your children and other people that visit your home frequently on the proper handling and care of German Shepherd dogs?  (Circle one)
YES NO
31.  Have you considered the long commitment of time and financial resources required for dog ownership?  (Circle one)
YES NO
32.  Is there a veterinarian that you use now or have used in the past?
YES NO
   If YES, please provide the following:
    NAME:
    ADDRESS:
    PHONE:
33.  If you do not have  a veterinarian, would you like a rescue representative to recommend a veterinarian in your area that is knowledgeable about German Shepherd dogs? (Circle one)
YES NO
34.  How did you find out about our organization?
   Veterinarian  (name)
   Shelter  (name)
   Newspaper (name)
   Friend (name)
   Other (describe)
35.  Would you consider volunteering for our organization?  (Circle one)
YES NO
     If YES, in which of the following areas:  (Circle all that apply)
Foster Care Transportation of Animals
Telephone Calling Interviewing adoption candidates
Computer Assistance Fundraising
Other:  (describe)

 

Thank you very much for taking the time to complete this questionnaire.  Your answers will permit us to more effectively match your needs with dogs in our program.

If you have any questions or concerns about adopting a rescue German Shepherd Dog or about this program, please use a blank piece of paper to share them with us.  We are always interested and open to your viewpoint.

When complete, you can mail this application to:

    Marianne Perlman
    9303 N. Kedvale
    Skokie, IL  60076

Or send via fax:   847-677-0562

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