First Name *
Last Name *
Spouse First Name
Spouse Last Name
Street Address *
Street Address 2
Home Phone *
Do you have herding dog experience? If not, why are you interested in adopting one of these breeds? Please explain why you would be a good herding dog parent. *
Work Phone Number
Spouse/Partner's Work Hours
List all Members living in your home and their ages *
Do you have young children visit on a regular basis? (i.e.grandchildren, babysitting, friends with small children)?
If yes, to the question above, list ages of the children visiting
Are you expecting a child, planning a family in the future? If yes, will the Herding Dog remain in the home?
How long have you lived at your current address?
Previous Address 2
Number of years at that previous address?
Is everyone in your home agreeable to adopting a rescued dog? If not, who and why?
For whom are you adopting this dog? If for someone else, please explain. Do they know?
Does anyone in your home have any known allergies? If so please explain:
Which of the following best describes your current living situation?
Own Modular Home
Rent Modular Home,
Live with Parents
Live with Others
If renting, Landlord's Name and Phone #
Social environment ( city, suburban, country)? Briefly explain:
Does your city or county have a limit on the number of pets per household? If so, what is that limit?
Does your home have a backyard?
Is your yard fenced? If so, what is the type and height of the fence?
Will the dog be left alone during the day? If so, where will the dog be kept and for how long?
Specifically, what will be the dog's living situation? (example, run of the house, kennel, outside kennel, garage, basement, tie out)
If you answered outside to the question above, please describe the fencing, kennel, dog house, example- is it heated in winter/ cooled in summer?
Where will the adopted dog sleep?
Will you attend obedience training with your adopted dog?
If not attending obedience training, how much time will you devote to daily training?
Preferred Age Range of Dog
Why do you want this rescue dog? What are your expectations?
What activities are you going to engage in with your adopted dog?
How long will you keep this dog? What if there is a major lifestyle change, or if the dog becomes ill, will the dog be given up?
Are you willing to adopt a dog with special medical needs? (example- daily eye drops, special diet or medication)
What do you consider behavioral problems?
Are you willing to adopt a rescue dog with behavioral issues like jumping on people, excessive barking, not house trained, etc?
What is your method of disciplining a dog?
Do you own a crate? What are your thoughts on crating?
Will you be able to continue the crate training? (good for housebreaking, boarding, hospital stays)
Are there other pets living in your home? (if not, skip this section)
What brand of food to you feed your pets?
List breed(s), age(s), and sex(es) of current/past 3 pets.
If you have an animal now, have you ever introduced it to a new animal? If yes, how did your current pet react?
Are all pets current on a vaccinations?
Are all of your pets spayed or neutered? If no, please explain.
If necessary, will you spay or neuter your current dog?
Are all of your current pets on Heartworm preventative. What brand? If no, please explain.
Veterinarian's Phone Number
File name for each of your pet(s) and additional owner name if different from yours.
Have you attended obedience training with your current or previous pets? If so, trainers name?
Do any of your current pets have behavioral issues? Have you had a pet with behavioral issues in the past? Is so, how do/did you handle it?
Are you willing to travel to pick up your adopted dog? If so, how far?
Have you applied to adopt from any other rescue groups? If so, what group(s)?
Do you understand that often times the complete history of a rescued dog may not be known? Is this acceptable to you?
Please provide the name, email address and phone number of a non- Related Reference
Please provide the name, email address and phone number of a Related Reference
Please list any dogs you are interested in from our All Herding Breed Dog Rescue site.
Where did you hear about All Herding Breed Dog Rescue and/or find the dog you’re interested in? *
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