Chicagoland German Shepherd Rescue

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Chicagoland Shepherd Rescue Adoption Application - Online



*note: Please fill in all fields. Where more than option is given, please check all that apply.

Date:

Personal Information:
Name:
Home Phone:
Address:
Work Phone:
City, State, Zip:
E-mail address:
When is a good time to call?:

Are you 18 years or older?:
yes no

Date of Birth:

Employer:
Work Phone:
Occupation:

Residence you live in?
House Apartment Condo Mobile Home Other (please explain) :

Type of area you live in?
Rural/Country Suburban Urban/City

Do you:
own rent
Name and phone # of landlord if you rent:

Does your lease have restrictions regarding animals?

yes no
Does your lease require a deposit for having animals?
yes no

Please list 3 references - 1 Business and 2 Personal references (none of which can be related to you or employed by you). Please contact your references and tell them to be expecting our e-mail reference request or telephone reference request. This section is mandatory. If you do not fill it out you will not be eligible to adopt from us.

Business Reference:
Name:
Work Phone :
HomePhone:
Email Address:

Personal Reference:
Name:
Work Phone:
HomePhone:
E-mail Address:

Personal Reference:
Name:
Work Phone:
HomePhone:
E-mail Address:

General Information: The information boxes below will expand to accomodate a lengthy answer.

Why do you want a dog and what would you like to do with him/her?


How did you hear about Chicagoland Shepherd Rescue?

Have you previously adopted from our organization?
no yes if yes, which dog:

Please provide the following information about the people currently living in your household:
Number of adults:
Number of Children:
Ages of Children:
Do you plan to have Children in the next 5 years?
yes no

If this Shepherd is for someone other than yourself, please explain:


Who will have primary responsibility for the care of the dog?
How many hours per day will the dog be left alone?
Where will the dog be kept during the following times?
day:
night:
when you are not home:


Where will the dog sleep at your home?


What animals have you owned in the past 5 years?
Pet's Name:
Type/Breed:
Kept Where?:
Age:
Neutered/Spayed:
Male/Female:
Still Own?

Pet's Name:
Type/Breed:
Kept Where?:
Age:
Neutered/Spayed:
Male/Female:
Still Own?

Pet's Name:
Type/Breed:
Kept Where?:
Age:
Neutered/Spayed:
Male/Female:
Still Own?

Pet's Name:
Type/Breed:
Kept Where?:
Age:
Neutered/Spayed:
Male/Female:
Still Own?

Pet's Name:
Type/Breed:
Kept Where?:
Age:
Neutered/Spayed:
Male/Female:
Still Own?

Do you have a veterinarian?
Yes
No
If Yes, please list the name of the clinic, the vet’s name and telephone # :


If No, how will you go about finding one?


About the dog, please tell us your preferences on the following:
Sex:
Male Female No Preference

Age:
Under 6mos 6 mos/ 1yr 1- 2yrs 2 - 4yrs 4 - 6yrs Under 6yrs No Preference

Color:
Black & Tan Black & Red Solid Black Solid White Sable Bi - Color No Preference

Are there any weight considerations?


Dog Type :
Purebred Shepherd-Mix No Preference

Coat considerations :
Regular Coat Plush Coat Long Coat No Preference

Is there a specific dog that you have seen on the web site that you would like to be considered for? If so, please give the name and what attracted you to him/her?


What other breeds have you considered?


What is it about the German Shepherd Breed that interests you?


Please check the 3 most important characteristics you want to see in your shepherd:
Active
Playful
Independent
Protective
Dominant
Intelligent
Loving
Calm
Aggressive
Submissive
Good with Kids
Good with Dogs
Good with Cats
Outgoing/ Friendly

Are there any characteristics that you are unwilling to work with?


Have you ever moved and not taken your pets with you?
no
yes

if yes, please explain:


How do you plan to discipline the dog?


We believe that all of our animals should have the opportunity to go to qualified obedience training. The adoption requirement for obedience training can only be waived for a dog by the unanimous vote of the adoption committee. If you plan on adopting from CSR –make sure you plan on attending obedience training with your dog. All of our dogs deserve the chance to bond with their new owners and to become ambassadors of good canine behavior to the community in which they live.
Will you be taking the dog to obedience class? yes no
If no, why not?

Also note – NO CSR dog can be trained in Shutzhund bitework.

Do you have plans for other types of training with your new dog? (i.e. agility, herding, therapy, search and rescue?)


Do you have a completely fenced yard?
yes no
If no, how do you plan on exercising your shepherd?

Describe the fence:
Height:
Type of fencing:
Number of gates:
Can people or children easily open the gates?
yes no
Do people or children have access to your yard when you are not home?
yes no

Where the dog will be kept when you are not home?:
Loose in the House Crated in the House Tied Outside in the Dog Run in the Garage Other
If chose Other, please specify:


Check how long the dog will be alone when you are not home:
Less than 3 hours 3 - 6 hours 6 - 9 hours 9 - 12 hours More than 12 hours
If the dog will be alone 6 or more hours per day, what arrangements will you make to allow the dog to relieve themselves?


Do you travel often?
yes no
If yes, how will you provide for the care of your dog while you are gone?


What is your favorite dog related book and movie and why do you like it?


Please write any additional information or comments here:




When the application is complete, please hit the Submit button only ONCE.