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Printed Application on the Web
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| This application is for those of you who cannot download the CSR application due to not having the program . If you cannot download the other application - then please print this one out - answer the questions and either fax it to the number at the bottom of the page or mail it to us at the address on the bottom of the page. |
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Chicagoland Shepherd Rescue Adoption Application
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| Date: _____________________________ |
| Personal Information: |
| Name _____________________________________ |
| Home Phone:_________________________ |
| Address____________________________________ |
| Work Phone: ________________________ |
| City, State, Zip_______________________________ |
| E-mail address:_______________________ |
| Are you 18 years or older? _____________ |
| Type of 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 you lease require a deposit for having animals? ___ yes ____ no |
| Drivers License Number :_______________________ |
| Employer: ___________________________________________________ |
| Work Phone :__________________ |
| Occupation: ___________________ |
| 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:____________ |
| Email Address: _______________ |
| Personal Reference: |
| Name __________________ |
| Work Phone :________________ |
| HomePhone:____________ |
| Email Address: _______________ |
| Please list the dog related clubs that you belong to? __________________________________________________________ |
| General Information: |
| 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? 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? |
| Name Type/Breed Kept Where Age Neutered (Y/N) M/F ? Still Own? (Y/N) |
| __________________________________________________________________________ |
| __________________________________________________________________________ |
| __________________________________________________________________________ |
| __________________________________________________________________________ |
| __________________________________________________________________________ |
| __________________________________________________________________________ |
| __________________________________________________________________________ |
| __________________________________________________________________________ |
| Do you have a veterinarian? If no, how will you go about finding one? __________________________________________________________________________ |
| Please list the name of the clinic, the vet’s name and telephone # : __________________________________________________________________________ |
| About the Dog |
| Please tell us your preferences on the following: |
| Sex: | Male ___________ | Female ___________ | Don’t care__________ |
| Age: | Under 6 months ________ | 6 months - 1 year ________ | 1-2 years ________ | 2-4 years _______ | 4-6 years _______ | Over 6 years ________ |
No pref._____ |
| Color: | Black & Tan __________ | Black & Red __________ | Solid Black __________ | Solid White __________ | Sable ________ | Bi-color ________ | No pref. ______ |
| Are there any weight considerations? __________________________________________________________________________ |
| Dog Type: | __________ Purebred | ____________ Shepherd/Mix |
| Coat considerations: |
Regular coat Shepherd ________ |
Plush coat Shepherd __________ | Long coat Shepherd __________ |
| 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? (If yes – please explain) _________________________________________________________________________ |
| 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? __________________________________________________________________________ |
| 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? __________________________________________________________________________ |
| Check where the dog will be kept when you are not home: |
| __ Loose in the house | __ Crated in the house | __ Tied outside | __ In Garage | __ In the dog run |
| Other: please describe __________________________________________________________________________ |
| 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 | __ 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 are gone? |
| _________________________________________________________________________ |
| What is your favorite dog related book and movie and why do you like it? |
| _________________________________________________________________________ |
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Please mail to:
Chicagoland Shepherd Rescue PO Box 147,Hines, IL 60141 fax to: 773-326-0652 |