*note: Please fill in all fields. Where more than option is given, please
check all that apply.
City, State, Zip:
When is a good time to call?:
Are you 18 years or older?:
Date of Birth:
Residence you live in?
Other (please explain) :
Type of area you live in?
Name and phone # of landlord if you rent:
Does your lease have restrictions regarding animals?
Does your lease require a deposit for having animals?
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.
Work Phone :
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
How did you hear about Chicagoland Shepherd Rescue?
Have you previously adopted from our organization?
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?
If this Shepherd is for someone
other than yourself, please explain:
Who will have primary responsibility for the care of
How many hours per day will the dog be left alone?
Where will the dog be kept during the following times?
when you are not home:
Where will the dog sleep at your home?
What animals have you owned in the past 5 years?
Do you have a veterinarian?
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:
6 mos/ 1yr
2 - 4yrs
4 - 6yrs
Black & Tan
Black & Red
Bi - Color
Are there any weight considerations?
Dog Type :
Coat considerations :
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
Please check the 3 most important characteristics you want to see in your
Good with Kids
Good with Dogs
Good with Cats
Are there any characteristics that you are unwilling
to work with?
Have you ever moved and not taken your pets with you?
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
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?
If no, how do you plan on exercising your shepherd?
Describe the fence:
Type of fencing:
Number of gates:
Can people or children easily open the gates?
Do people or children have access to your yard when
you are not home?
Where the dog will be kept when you are not home?:
Loose in the House
Crated in the House
in the Dog Run
in the Garage
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?
If yes, how will you provide for the care of your dog while you
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