Adoption Questionnaire

Version 03-Sep-07

Thank you for filling out this questionnaire. Your answers will help us assign an adoption counselor to work with you and match your needs with the dogs in our program.

Please complete this form, then:

Print a copy to keep for your reference;
Make a second copy to take with you to Adoption Day events;
Electronically submit this form (see "Submit" button at bottom of questionnaire)
or
Mail a printed copy to:

German Shepherd Rescue of Northern California, Inc.
P.O. Box 1930
Cupertino, CA 95015-1930

Last Name	First Name:
Address:
City:		State: Zip:
County:
Phone	Day: Evening: Cell:
Email:

Who will be responsible for the dog’s care?
Check all that apply and indicate which person will have primary responsibility.

Primary	Adult	Name:
Primary	Adult	Name:
Primary	Child	Name:	Age:
Primary	Child	Name:	Age:
Comments:

Name and city of your veterinarian:

May we contact your current veterinarian regarding your current or previous pets?

Do children live or regularly visit your home?
Please indicate how many children in each of the following age groups:

Live In:
under 1 year
1-3 years
4-7 years
8-12 years
older than 12 years

Visitors:
under 1 year
1-3 years
4-7 years
8-12 years
older than 12 years

Please tell us about your current pets and animals, including any livestock.

Species:	Breed:	Gender:	Age:
Primary Living Area:	Spayed/Neutered? Yes No	Where does this animal sleep? Inside Outside
Comments:


Species:	Breed:	Gender:	Age:
Primary Living Area:	Spayed/Neutered? Yes No	Where does this animal sleep? Inside Outside
Comments:


Species:	Breed:	Gender:	Age:
Primary Living Area:	Spayed/Neutered? Yes No	Where does this animal sleep? Inside Outside
Comments:


Species:	Breed:	Gender:	Age:
Primary Living Area:	Spayed/Neutered? Yes No	Where does this animal sleep? Inside Outside
Comments:

What happened to previous dogs you no longer have?

Breed:	Age:	Disposition:
Comments:


Breed:	Age:	Disposition:
Comments:

Please describe your residence:
Own Rent (written landlord agreement required)
House Condo/Townhouse Apartment Farm or Ranch

Please describe fencing in the yard or exercise area where your dog will be outside:
Fenced yard Partially fenced yard Fenced yard area for dog
No fence "Invisible" fench Enclosed dog kennel/run
No yard

8.	Indicate height of your fence at its lowesst point: 4' or less 5' 6' or higher No fence
9.	Please tell us about your personal experience with dogs: Never had a dog Never had a dog as an adult, but grew up with them Have spent a lot of time with dogs owned by others Have spent a lot of time with German Shepherds owned by others Have (had) family dog(s) that were not German Shepherds Have (had) a German Shepherd Have (had) several German Shepherds
10.	Please tell us about your experience training dogs. Check all that apply: None Read books and magazines Attended seminars or took online courses Pet store classes Group recreational classes Private recreational classes Agility, flyball, other recreational sports classes Intermediate or advanced classes Formal advanced training for competitive obedience or dog sports Earned working titles Professional level military, service, or law enforcement work
11.	What roles do you want the dog to play in your and your family's life? Check all that apply: Household pet Companion for adults(s) Companion for children Companion for other dogs Companion for pets other than dogs Hiking/Jogging Partner Personal service dog or therapy dog Protection Guard dog Professional working dog (i.e., search & rescue, narcotics or bomb detection) Other (please explain)
12.	What kinds of activities do you want to participate in with your dog? Check all that apply: Neighborhood walks, backyard games Visits to dog parks (off leash with other dogs) Hiking, jogging, or running Day trips (e.g., to the beach) Horseback riding Structured obedience, canine good citizen Recreational dog sports (agility, flyball, etc.) Competitive dog sports (obedience, rally agility, hearding, tracking, Schutzhund) Volunteer working activities (search and rescue, therapy) Professional working activities (security, protection, narcotics or bomb detection, human remains detection, personal service dog, law enforcement Other (please explain)
13.	How long will your dog be alone during the typical weekday? Rarely 2-4 hours 4-7 hours 7-10 hours More than 10 hours
14.	Where do you want your dog to spend its time? Inside fulltime, outside rarely Inside most of the time with access to outside, sleeps inside Inside when you're home, outside when you're gone Mostly outside in yard, rarely in house, sleeps in garage or dog house Outside only
15.	What type of dog would you prefer? Gender: Male Female No Preference Age (check all that apply): Puppy (under 6 months) Puppy (6 months - 1 year) Young adult (1 -3 years) Adult (3 - 5 years) Adult (5 - 7 years ) Senior (older than 7 years)
16.	Do you have any additional comments to help us find the right dog for you?
17.	How did you hear about GSRNC? Friend Adoption day or other event Newspaper Web search Veterinarian Other (please explain)

The average cost of caring for our dogs, including shelter fees, spaying/neutering, veterinary care, boarding and feeding exceeds $400 per dog. We ask for a minimum adoption fee of $200 to cover these costs, Any additional contribution you are able to make will be much appreciated.

German Shepherd Rescue of Northern California is a non-profit all-volunteer organization .

We thank you for your interest in German Shepherds!