Chesapeake Shepherd & K-9 Rescue, Inc.

Adoption Application

Personal Information (Note: Applicants and Co-Applicants must be at least 18 years of age)

Applicant Information
First Name:	Last Name:
Street Address:
City:	State:	Zip:
Home Phone:	Work Phone:	Cell Phone:
Email:

Co-Applicant Information
First Name:	Last Name:
Home Phone:	Work Phone:	Cell Phone:
Co-Applicant's Relationship to Applicant:	Spouse/Partner Parent/Guardian Child Roommate Other
Email:

Are you currently expecting a child? Yes No

Are you considering having a child in the next 10 years? Yes No

Explain how you would resolve issues relating to new children and your dog:

Have you considered the full ramifications of taking a dog into your family for the rest of its life- through illnesses and old age? Yes No

Have you considered that having a dog through its lifetime might, over time, require changes to your life, including providing your dog with more frequent opportunities to eliminate, or adjusting your routine to allow your dog to avoid stairs as old age sets in? Yes No

Housing Information

Type of dwelling: Single family Townhouse Apartment Condo
Do you: Own Rent
If you rent, is there a weight limit on dogs in your rental property? Yes No
If you rent, landlord's name:	Phone Number:
(Note: Your application will be denied if we cannot reach your landlord after repeated attempts)
If you have a yard, is it fenced? Yes No
If yes, height and material:
If no, how will you handle exercise and toilet duties?
What will happen to this dog if you move?

General Information

Please list all residents of your household (other than applicants):

Name:	Age:
Name:	Age:
Name:	Age:
Name:	Age:

If you have children, what is their experience with dogs? (check all that apply)
N/A Lived With Frequent Some None Large dog Small dog

If you have children, how will you prepare them for the addition of a dog to their family?

Who will be the primary caretaker of this pet?

Approximately how many hours per day will your dog be alone?

Where will your dog spend time when you are not home? (Check all applicable):
Open home Crate Kennel Fenced yard Other

What are your goals for this dog? (Check all applicable):
Companion Obedience Agility Search & Rescue

What are your plans for crate use? (Check all applicable):
No crate Reluctant to crate Crate if necessary Temporarily crate Permanently crate

Have you ever crate trained a dog before? Yes No

Have you ever housetrained a dog before? Yes No

Have you ever obedience trained a dog before? Yes No

How much do you think it will cost to take care of your dog each year (food, vet care, license, toys, supplies, training)?

What do you consider to be a reasonable amount of time to allow the dog to adjust to your home?

General Information Continued

Have you owned a German Shepherd before? Yes No

Have you owned any other breed of dog before? Yes No

If yes, please list all dogs you have owned in the past ten (10) years:

Breed	Sex	Age	Current or Deceased?	Spayed or Neutered?
	M F		C D	Y N
	M F		C D	Y N
	M F		C D	Y N
	M F		C D	Y N

Please list any pets who will be in contact with this dog (type, sex, age for each):

Do you have a regular veterinarian? Yes No

Veterinarian's Name:

Street Address:

City: State: Zip:

Phone Number:

Please list the name of three references (not family members):

Name:

Phone:

Name:

Phone:

Name:

Phone:

Please list the name(s) of the dog(s) for which you would like to be considered:

Please add any comments you may have in the following space:

Thank you for your interest in adopting from Chesapeake Shepherd & K-9 Rescue, Inc. Please allow 1-3 weeks for the processing of your application. If you are approved, you will be contacted by an adoption coordinator to schedule a home visit. If you have not heard from us within 3 weeks, please consider your application denied. Additionally, please bear in mind that the placement of dogs is NOT based on a first come first serve basis and instead a "best match" process is utilized.

I/we acknowledge that all the information on this form is true and correct. I/we understand that any misrepresentation of fact will result in the denial of my application or the removal of the adopted dog from my home by CSK9, and all fees paid by us to CSK9 will be forfeited.


Applicant Signature:	Date:
Co-Applicant Signature:	Date:

"A harbor, even if it is a little harbor, is a good thing, since adventures come into it as well as go out, and the life in it grows strong, because it takes something from the world and has something to give in return." -Sarah Orne Jewett, from "River Driftwood" (1881)