4817 Big Horn Ave, Sheridan, WY  82801

ADOPTION QUESTIONNAIRE FOR A GSD RESCUE

Your answers to this questionnaire will help us to match your needs with the German Shepherd Dogs in our program.

Please Print!

NAME:            ____________________________________________________________           

ADDRESS:      ____________________________________________________________           

                        ____________________________________________________________

PHONE:          DAY (     )  ___________________            EVENING:  (     ) ______________________ 

 E-mail Address:           _________________________________________________________________

Employer:         _____________________________________  

How long  ______  Phone _________________

Employer:         _____________________________________  

How long  ______  Phone _________________

Please list two references:

Name:              ___________________________________________________

Address:           ___________________________________________________      

Phone:  _________________

E-mail Address:           __________________________________________________________________

Name:              ___________________________________________________

Address:           ___________________________________________________      

Phone:  _________________

E-mail Address:           __________________________________________________________________

 Please check your preference:

 1.        Sex:                  _____  Male                _____  Female             _____  Either    

 2.        Color:               _____ Black/tan                       _____  Black/silver                   _____  Solid Black

                                     _____  White                           _____  Sable                            _____  no preference

  3.        Age:                 _____  under 1 year                 _____  2 - 4 years                    _____no preference

                                     _____  1 – 2 years                   _____  over 4 years

 4.         Who is this German Shepherd for?

  5.        Have you owned a German Shepherd or any dog before?  (If yes, please provide a brief history on the  back of the page)

  6.        What is it about German Shepherd Dogs that has generated your interest in the breed?

  7.        What other breeds have you considered?

8.        What are the THREE characteristics you find most appealing about a new German Shepherd?  (Choose three and number the choices:  1 = best; 2 = 2^nd best; 3 = 3^rd best)

 _____  active               _____  protective         _____  calm                 _____  aggressive

 _____  playful              _____ dominant           _____  intelligent          _____  submissive

 _____  independent      _____  shy                   _____  loving

 _____  other  __________________________________________________________

  9.        To facilitate the bonding process we recommend every new German Shepherd should attend some introductory obedience training.  Would a formal obedience training program be something you, as a new owner, would be interested in participating in?  (If NO, please provide a brief explanation.)

 _____   YES                _____  NO, because   ___________________________________________________

________________________________________________________________________________________

10.       What kind of work or behaviors do you expect of this dog?

 11.       What would be your response if he made a mistake?

 12.       What amount of time and effort do you want to devote to training him?

 13.       What is your definition of disciplining a dog?

             What is your initial reaction to the idea of disciplining your dog?

 14.       Which of the following best describes your current residence?  (Check one)

             _____  Own a home                                                     _____  Rent/Lease a home

             _____  Own/rent/lease a townhome (multiple family dwelling)

             _____  Other ______________________________________________________________________

             (Please note:  If you rent/lease your residence a copy of the lease will be requested before the adoption is finalized.)

15.       Do you have a fence?   _____  Type ________________________________           Height ________

            Is the fence secure and solid?  ____________________________________

            What type of gates?  ____________________________________________

            Can children open the gates?  _____________________________________

16.       What kind of improvements are needed to provide a secure yard?

17.       Are you willing to make the improvements?  _______

            When and how long will it take? 

18.       If you have a pool, is it fenced?

19.       If you have a dog run, is it secure?

20.       If you do not have access to a fenced area, would you like your rescue representative to provide recommendations on the safe confinement of your dog?

_____  Yes

_____  No, because I already have made the following arrangements (describe):                      

 21.       Have you checked the yard for dangerous articles, plants or anything the dog could use to climb the fence?

 22.       Are you aware of any distractions outside your yard that could plague the dog, such as neighbors’ dogs, loose dogs on the street, mischievous children?

            _____  3 hours or less

            _____  more than 3 hours but less than 6

            _____  more than 6 hours but less than 12

            _____  more than 12, but less than 18

            _____  more than 18, but less than 24

25.       How many people currently live at your residence?  (Please list each below)

            Name                                                               Relation to You                                                Age

          ____________________________________________________________________________________

            ____________________________________________________________________________________

            ____________________________________________________________________________________

            ____________________________________________________________________________________

26.       Who will have primary responsibility for the care of your German Shepherd?

27.       Have you and your family discussed the pros and cons of owning a German Shepherd?

28.       Have you asked yourself whether your lifestyle is so busy that you might not have the time or energy to properly care for a German Shepherd?

29.       Is your lifestyle such that friends, relatives and children can gain admittance to your home, property or car without your supervision?

30.       If you have children, are you willing to accept the additional responsibility of a German Shepherd?

31.       Are you willing to teach the children the proper way to handle a live animal?

32.       Are you willing to accept that the dog may not like all your children’s friends?

33.       Does everyone in the family want a dog?

34.       What is your family’s overall reaction to owning a dog?   

            What members are enthusiastic?                                    Unenthusiastic?

            What complaints have been made?

35.       Have you and your family considered that a dog lives for years?  Are you willing to accept the commitment?

 36.       Have you considered the financial cost of dog ownership? 

Are you financially prepared to give your dog the routine medical care it requires?

 37.       Have you carefully considered how the dog will fit into your lifestyle?

 38.       Do you intend to keep the dog primarily indoors or outdoors?  Please elaborate.

            Name                           Type of Pet                  Sex/Age                       How long owned          Kept Where

          ____________________________________________________________________________________

           ____________________________________________________________________________________

            ____________________________________________________________________________________

            _____ NO                   _____ YES (please provide a brief explanation)

43.       Do you have a veterinarian you have used before and plan to use with your new German Shepherd?

 44.       If you answered NO to question #43, would you like your rescue representative to recommend a veterinarian in your area who is especially knowledgeable about German Shepherd Dogs?

_____  Yes

_____  No, because

 45.       How did you find out about our organization?

             _____  Veterinarian (Name ___________________________________________)

            _____  Shelter  (Which one ___________________________________________)

            _____  Newspaper (Which one ________________________________________)

            _____  Website (Which one __________________________________________)

            _____  Friend  _____________________________________________________

_____  Other  ______________________________________________________

 46.       Would you consider volunteering for our organization?

             _____  Yes                  _____  No

            If yes, in which of the following areas?

            _____  foster care

            _____  transportation of animals

            _____  telephone calling

            _____  personal interviewing of adopting candidates

            _____  computer assistance

            _____  fundraising

            _____  other?  ______________________________________________________

Thank you for taking the time to complete this questionnaire.  Your answers will permit us to more effectively match your needs with dogs in our program.

If you have any comments or concerns about adopting a rescue German Shepherd Dog or about this program please use the back page to share them with us.  We are always interested and open to your viewpoint.