Date :
Applicant's Name :
Co-Applicant's Name :
Street Address :
City :
State :
Zip Code :
If you are a Houston area resident, please state the area
(i.e. NW, SE, Galleria, etc.):
Daytime Phone Number :
Evening Phone Number :
Email :
Fax :
Occupation of Applicant :
Occupation of Co-Applicant :
How many adults are currently living in your home?:
How many children are currently living in your home?:
Ages of children:
Do all family members wish to own a GSD?:
Do you live in a :
Do you own or rent your home?:
If you rent, Landlord's name:
and Landlord's phone:
Is your yard totally enclosed by a fence?:
Height of fence:
Do you own an outdoor kennel run:
Kennel description:
List current pets, including type (dog, cat, etc.), age and gender:
List former pets (and type) that have shared your life during the past five years, detailing what happened to them (1) natural death due to age, (2) illness, (3) euthanasia, (4) accident, (5) given away/reason(s):
Veterinarian's Name:
Veterinarian's Phone Number:
Date of last visit:
Reference #1 Name:
Reference #1 Phone Number:
Reference #2 Name:
Reference #2 Phone Number:
Why do you want a GSD?:
(check all that apply)
Please explain in detail your idea of the GSD personality type and energy level that would fit best in your home: Elaborate on the reasons why you would like your next dog to be a Rescued German Shepherd Dog:
List any step-children, grandchildren and others, including their ages that visit on a regular basis (week-ends or vacations):
Is there anyone at home who might be adversely affected by a dog (i.e. allergies)?:
Are you aware that a GSD is a large dog and it may jump up and knock down children and/or the elderly?:
Who will be responsible for the care of the dog?:
Where will the dog be kept during the day?:
Where will the dog be kept at night?:
Are you familiar with the use of a crate to train and/or confine the dog in your absence or when you are not able to adequately supervise a puppy to
keep him/her out of trouble?:
Will your dog have the run of the house? :
Will the dog be tied outside or live in the yard? :
Describe your dog training experience:
Will you take your GSD that you adopt from us to obedience training?:
How will you discipline your GSD?:
What will you do with your dog when you go on vacation?:
If you move, what will you do with your dog?:
Are you willing to take responsibility for this dog for 10 years or more?:
Are you aware of the costs involved in taking care of a large dog each year (vet care, licensing, food, toys,treats, obedience training - min. $1,200)?:
What heartworm preventative will you use?:
What steps will you take to control fleas?:
We require that all dogs be spayed/neutered prior to adoption, do you have any questions about this policy?:
If you are unable to care for your dog in the future, who will accept responsibility for its care? :
We try to follow up on the welfare of our adopted dogs - would you mind a visit or a call?:
Gender Preferred?:
( All dogs are spayed/neutered prior to adoption. )
Dogs listed on our site in which you are interested:
Please feel free to add any other information that you think might be helpful to us in evaluating your application: