Printed Application on the Web
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.
Chicagoland Shepherd Rescue Adoption Application
Date: _____________________________
Personal Information:
Name _____________________________________
Home Phone:_________________________
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 :________________
Email Address: _______________
Personal Reference:
Name __________________
Work Phone :________________
Email Address: _______________
Personal Reference:
Name __________________
Work Phone :________________
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


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?
Please mail to:
Chicagoland Shepherd Rescue
PO Box 147,Hines, IL 60141

fax to: 773-326-0652