North American Dutch Shepherd Rescue Pre-Adoption Application

Ownership of a Dutch Shepherd (DS), like any dog, is a serious responsibility that requires a long-term commitment. It is the goal of The North American Dutch Shepherd Rescue (NADSR) to be sure that this responsibility, as well as the financial and psychological needs of each dog, be met in its new home. This pre-adoption application has been designed to help prospective Dutch Shepherd adopters address the impact that adopting a rescued DS can have upon their home and the suitability of their home for a Dutch Shepherd. This form shall also aid NADSR in applicant evaluation.

Send Form To:

Trudy Donais

Applicant(s) Information:

Name(1): Date:

Name(2):

Address:

City: State: Zip:

Email:

Home Phone: Cell Phone:

Occupation(s): Employer:

Occupation(s): Employer:

Household Information:

# of Adults in Household: # of Children in Household

Please list gender and age(s) of children (if this is not applicable to you please put N/A):

Who will be responsible for the care and training of your new DS?:

Approximately how long would you expect your DS to be alone each day?:

Do you live in a:
Single Family Home
Mobile Home
Condominium
Apartment

Do you own or rent:
Own
Rent

If you rent or lease you must have written permission from your landlord. Please provide a copy of the rental or lease agreement with the pet clause and list your landlord's information:

Name: Phone:

Address:

City: State: Zip:

Is your yard:
Fenced
Unfenced
If yes, please note approximate size of fenced area and height and type of fencing material, if not put N/A:

If your yard is not fenced, would you fence all or part of it as a condition of adoption?
Yes
No

Are you willing/able to modify your daily schedule to accomodate a DS's needs, such as going outdoors into a fenced area or walking on a leash to perform bodily functions at least 4 times daily?
Yes
No
Are you aware of the importance of keeping a DS on leash or in a fenced area?
Yes
No
Dutch Shepherds placed by NADSR must reside in the house. They are not to live outdoors regardless of whether or not you have a kennel or dog house or an attached run. They also cannot be chained or tied outside. Do you agree to these conditions?
Yes
No
Is there a local ordinance in your area pertaining to owning/housing an animal (i.e. leash laws, required vaccinations, dog licenses etc)?
Yes
No
Are you willing to keep a collar with a tag bearing your name, address, phone number etc on your DS at all times?
Yes
No
If, for any reason, you are unable to keep your DS, will you agree to return it to this rescue organization?
Yes
No
Are you willing and able to accept full care, costs, necessary burdens and responsibility of owning a pet?
Yes
No

Previous Experience Owning Pets

How many dogs have you owned in the past Five years?

Please list each dog(s)' breed, name, gender and age (if you no longer own the dog please note what became of it. If this is not applicable to you please put N/A):

What other pets, if any, do you have?

Have you ever bred or raised dogs?
Yes
No
Have you ever participated in dog shows?
Yes
No
Have you ever trained a dog before?
Yes
No
If yes, what commands did you teach?
Are you familiar with crate training?
Yes
No
If not, would you be willing to learn more about it and consider the use of a crate (portable cage) as a training and transitional aid?
Yes
No

Household Activity

How would you describe your household activity level?
Very Quiet
Rather easy-going
Usually something going on
Lots of activity

Estimate the number of times per month that adults visit your home:

Estimate the number of times per month that children visit your home:

In addition to regular life at home, would your DS:
Walk routinely with a family member?
Compete in obedience trials?
Go to obedience class?
Go to your place of business with you?
Travel with you?
Compete in organized breed events?
Be a playmate for your children or pets?
Participate in continued training of some level?

Preferences and References

Would you prefer a male or a female Dutch Shepherd?
Male
Female
No Preference

Occasionally, a DS with special needs (i.e. physical restrictions or unusual personality/preferences) is available for adoption. Would you be interested in being considered for such a "special" dog?
Yes
No

Please add any additional information or thoughts that you feel would help us to understand you and your home as a potential Dutch Shepherd owner(s):

Do you currently have a veterinarian?
Yes
No
If yes, please list your veterinarian's name address and phone number below:

Name: Address:

City: State Zip:

Phone:

Please list two personal references that you have known for more than two years that are not relatives:

Name:

Address:

City: State: Zip:

Phone: Email:

Name:

Address:

City: State: Zip:

Phone: Email:

I understand that in order to complete processing of this application a visit to my home may need to be scheduled by a representative of the program, and that by submitting this application I agree to such a scheduled visit. I also agree that the rescue organization or parent breed club may contact the listed references or veterinarian for additional information. I authorize those listed to disclose any information (medical or otherwise) requested by the representative. I also certify that all information on this adoption application is true and correct.

Signature: Date:

Signature: Date: