About You

(PLEASE NOTE: * = required fields)

*Name:

*E-mail:

*Phone:

Address:

City, ST Zip:

Age:

Employer:

Hours you are at work?

Work Phone:

May we call you at work? YesNo

How did you hear about us? (Internet, Advertisement, Friends):

About Your Home

1. Do you have any special training or experience in working with dogs?: YesNo

2. Do you currently have any other animals?: YesNo

If yes, please list: type, age & sex and if they are spayed/neutered. If your pets are not spayed or neutered, please explain why?:

3. Do you keep all of your pets up-to-date on all shots? YesNo

If not, explain why?:

4. Do you keep all of your pets up-to-date on heartworm prevention medication? YesNo

If not, explain why?:

5. Do you keep all of your pets up-to-date on flea prevention medication?: YesNo

If not, explain why?:

6. Do you keep all of your pets licensed in your county?: YesNo

If not, explain why?:

7. Are your pets vaccinated against Kennel Cough? (If not, they will need to be) YesNo

8. Which brand of heartworm and flea prevention do you use for your pets?:

9. Do you currently have a Veterinarian?: YesNo

Name of Vet: Vet Phone #:

10. Can we use your vet as a reference?: YesNo

11. Do you live in a: HouseApartmentCondoOther

12. Do you own or rent your home?: OwnRent

13. If renting, what is the name and phone number of your Landlord?:

14. If renting, does the landlord allow pets?: YesNo

15. Do you have a fenced yard for the dog to use?: YesNo

If not, how will you exercise the dog?:

16. Is your yard securely fenced on all sides?: YesNo

17. Does a door from your house open directly into the fenced yard?: YesNo

18. Is anyone home during the day? YesNo

Who and for how long?

If not, what hours would this dog be left alone?

19. Where will this dog stay during the day, while you are at work?:

20. Who lives with you (ie..Mom-Dad-2 kids)?:

21. Please list ages of everyone living (even part-time) in your home:

22. Who, other than you, will be responsible for the care of this dog?:

23. Are you able to keep a dog that is not good with children?: YesNo

24. Are you able to keep a dog that is not good with cats?: YesNo

25. Please check all that apply in your home:
Busy household-visits from friends, in and out, children, parties at homeNoisy-TV, stereo, machinery, tools, children playing, dogs barkingModerate-normal comings and goingsQuiet-"homebodies" few guests, come home and stay homeLots of children in the neighborhoodLive on a busy street

26. Where do you intend to keep this dog: IndoorsOutdoors

27. Please tell us what supplies you already have for a foster dog:
Large crateLeashFood and water bowlsBrush

28. Would you be able to supply a premium dog food to the foster dog, or would you need us to? YesNo

29. Have you ever owned a Sheltie before?: YesNo

30. Have you ever handled a very scared dog?: YesNo

31. Have you ever taken a dog through an obedience class?: YesNo

32. Have you ever handled an aggressive dog?: YesNo

33. Are you able to help housetrain a dog?: YesNo

34. Are you able to take a "special needs" (blind, deaf, sick) dog?: YesNo

35. Are you able to administer medication in a timely manner?: YesNo

36. Are you able to work with a "behavior problem" dog? (we don't take known biters): YesNo

37. Are you aware of all a Shelties needs? (ie.. grooming, exercise): YesNo

38. Are you aware that Shelties are barkers?: YesNo

39. Are you aware that Shelties may be somewhat shy around new people, and may take awhile to bond with?: YesNo

40. Do you have the time to offer these needy animals the extra attention and love required for their adjustment prior to permanent adoption?
YesNo

41. Please specify which tasks you are willing to perform:

YesNo  -  Respond to calls from pounds and identify if a dog is a Sheltie.

YesNo  -  Search newspapers and Internet for Shelties for adoption.

YesNo  -  Bail Shelties from pounds and hold until rescue can make arrangements for foster care.

YesNo  -  Transport dogs to foster homes or vet.

YesNo  -  Groom and bathe rescued Shelties.

YesNo  -  Foster Shelties for extended time periods.

YesNo  -  Interview potential adopters and perform home checks.

YesNo  -  Post information about Sheltie Rescue at local vets or on the Internet.

YesNo  -  Contribute Equipment, such as crates.

Verification

41. Please list two people who can offer references on your ability to care for our dogs:

Reference Name #1:

Phone #:

Reference Name #2:

Phone #:

Comments

If you have any personal comments you would like to share with us please leave them here:

Your Agreement is Required

I have agreed to give care and shelter to a rescued Sheltie for a limited period. I understand that I am accepting this dog as my own until a new home can be found. I also understand that Mid Florida Sheltie Rescue has no prior knowledge of this dog's temperament, and I will therefore take all due care to protect others and myself who may come in contact with this animal from bodily harm.

I will indemnify and hold Mid Florida Shelite Rescue blameless from damage to property or harm to persons or other animals caused by this animal.

I have read the above and agree to abide by the rules and regulations of Mid Florida Sheltie Rescue. I understand that members of the group are available to answer questions and offer advice, and I must contact them should any problem arise.

I agree that all of the answers I have given, are true and correct to the best of my knowledge.

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