SHETLAND SHEEPDOG RESCUE CLUB OF SOUTHERN MD

APPLICATION FOR ADOPTION

Name: ____________________________________________________

Address: __________________________________________________

City: _______________State____________Zip________Phone_______

Occupation: _____________________Work Phone: ________________

Email: ____________________________________________________

l. Why do you want a Shetland Sheepdog? ________________________

_________________________________________________________

2. What happened to your last dog? _____________________________

3. Have you ever owned a Sheltie before? _________________________

Do you still have that dog?

4. During the last two years:

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

b. Have you had one poisoned? ______________________________

c. Have you had an animal killed by a vehicle? ___________________

d. Have you had an animal die due to disease? ___________________

If yes, what did it die of? _________________________________

5. For what purpose do you want this dog? ________________________

6. Do you have any other animals? ___________List type, age and sex:

_______________________________________________________

7. Do you have children at home? _______Number:_______Age(s)______

8. Do you live in a house?____ Apartment____Condo_____Trailer______

9. Do you own or rent? _______________________________________

10. If you rent, do you have the landlord's permission to keep a dog?______

______________________________________________________

11. Do you have a yard? _____________Is it fenced? ________________

What type of fencing? _____________________________________

12. Do all family adults work? ________Is someone home during the day?

Please explain: ___________________________________________

13. What provisions will be made for your Sheltie if nobody is home during

the day? _______________________________________________

14. Do you intend to keep this dog indoors? _______________________

Where will it sleep? _______________________________________

15. Do you have a sex preference? No_____Male:______Female________

16. Do you have a color preference? No________Color_______________

17. Would you consider? The opposite sex? _______________________

An older dog? ____________________To what age?_____________

18. What size sheltie do you prefer? ______________________________

19. Are other members of your household aware that you are considering

adopting a pet?__________________________________________

20. Are you prepared to assume the financial responsibilities of caring for an

animal, including innoculations, veterinary care, good quality food,

licensing, etc? ___________________________________________

21. Are you planning to move in the near future? _____________________

22. Is anyone in your house allergic to animals? _____________________

23. Are you familiar with animal control regulations? __________________

24. Do you understand that any rescue sheltie that you may adopt through

Shetland Sheepdog Rescue Club of Southern MD will be spayed/

neutered? ______________________________________________

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? ____________________________________

27. How did you hear about the Shetland Sheepdog Rescue Club of

Southern MD? __________________________________________

28. Do you accept that there will be a $200 adoption fee for the adopted

dog? _________________________________________________

29. Are you willing to adopt a sheltie mix? Yes_________No__________

30. Name and telephone of veterinarian: ___________________________

______________________________________________________

I am in full agreement with the Shetland Sheepdog Rescue Club of Southern

MD "Terms of Adoption" (attached). By signing below, I am attesting to the

truthfullness of my answers. I understand that falsification of any of the

above information will be grounds to disallow the adoption of a rescued

Sheltie.

__________________           __________________________

Date                                                       Signature 

sign this application. Thank you for considering a dog from the Shetland

Sheepdog Rescue Club of Southern MD. If you have any questions, or

if we can be of assistance, please do not hesitate to call.

Rescue reserves the right to refuse any applicant

Please return to: Shetland Sheepdog Rescue Club of Southern MD

c/o Elaine Quade

24485 Mervell Dean Road

Hollywood, MD 20636

Phone: 301-373-2695