Name:

Date of Birth:

Address:

City:      State:      Zip: 

Home Phone:      Work Phone: 

Email Address: 
****We do a good deal of our correspondence via email.  Please check your email regularly after submitting an
application.  If you cannot leave an email address, it may take longer before you are contacted, as our adoption
coordinator cannot make rescue calls during the day from work.

Type of residence: choose answer house apartment duplex mobile home other   Do you rent or own? choose answer Rent Own
Landlord name:     Phone number:
If you rent or lease, your landlord will be contacted and a copy of the lease showing pet allowance 
will be required before adoption is finalized.

How many adults live in your household? How many children?

Please provide their full name(s) and age(s):

Employer:      Length of Employment: 

Please list two personal references:
1.    Name:      Relationship: 
       Address:      Phone: 

2.    Name:      Relationship: 
       Address:      Phone: 

Do you have a regular veterinarian?    Yes    No
****We will call your veterinarian as one of your references, so please fill in all information as requested.  Even if you don't
have a dog - if you have other pets and you have a vet, we need your vet's information.
Veterinarian's Name: 
Clinic Name:     
Clinic Address:      Phone: 
If you do not have a regular vet, you will be asked to obtain one before adoption is formalized.

Are all of your pets spayed or neutered?   Yes    No
Are all of your pets current on vaccinations?  Yes    No
Are all of your dogs tested for Heartworm and given preventative?   Yes    No
Do you administer regular flea and tick preventative to your pets?   Yes    No
If you answered NO to any of the above 4 questions, please explain:

What do YOU consider an acceptable reason for you to give up a pet?

Are you working with another rescue? If so, who?


Is there a specific dog on our website in which you are interested?  Name of dog: 
If there is not a specific dog, please tell us about your preferences:
Sex:  no preference male female     Color:  no preference black and tan black and red black white sable     Age:  no preference < 1 year 1-2 years 3-5 years 5-8 years > 8 years

Have you owned a German Shepherd before?  Yes    No

Please tell us why you are interested in a rescue GSD:

Please tell us a little about dogs that you've owned:

We highly recommend every German shepherd and it's owner attend an obedience training
class.  Please tell us about your plans for obedience training:

German Shepherds, like many other breeds, tend to have a lot of energy.  Exercise and
containment plans must be made.  Please tell us if you have any of the following:  none fenced yard dog run kennel

If you have a fenced yard, please tell us what type of fencing you have:

Please tell us about your containment plans:

How many hours a day will your dog be alone? 

Do you plan to crate your new dog?  choose answer yes no what's a crate?   Please let us know you thoughts on
crating:

Do you plan to house the dog primarily indoors or outdoors?  choose answer indoors outdoors
Please explain your plans:

We like to get to know our prospective adopters and their families.  Please tell us a little about
all members of your family:

PLEASE NOTE:  Because many of the GSDs taken in by GSRAW were listed by shelters as strays and have an
unknown history, it is possible these dogs have had little to no exposure to children, have a fear of children, or in
rare instances have been abused by children, we feel that some of our available dogs would not be a good match
for families with children under 8 years of age.  If that is the case, we would be happy to keep your application on
file until a compatible dog comes in.  We can also give you tips on how to find a reputable breeder in your area.

Please tell us about all pets that you currently have in your family:

How did you learn about our organization?

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

Release:
By submitting this document, you are stating that all the information given herein is accurate
and complete and that you are hereby giving your consent for GSRAW to verify any and all
information contained herein.  The completion of this form does not entitle you to any
guarantees or rights.  GSRAW will not be held liable in any way, for any dog, or its actions, once
the dog has been placed.