Name:        *
     Address:     *
     City:        *
     State:       * Zip Code: 
     Phone:       *
     E-mail Addr: *
     Occupation:   
     Occupation:   


How many dogs have you currently own? 

Please list the four most recent dog(s)you've owned:


Breed:  Gender:  MaleFemale Age:  How Long:  

Breed:  Gender:  MaleFemale Age:  How Long:  

Breed:  Gender:  MaleFemale Age:  How Long:  

Breed:  Gender:  MaleFemale Age:  How Long:  


4. Please tell us about other pets you have in your home.
 

5. How many dogs have you owned in the past? 
 

Breed:  Gender:  MaleFemale Age:  How Long:  

Breed:  Gender:  MaleFemale Age:  How Long:  

Breed:  Gender:  MaleFemale Age:  How Long:  

Breed:  Gender:  MaleFemale Age:  How Long:  


6. Have you ever participated in dog show, obedience or dog sports?
Yes No

7. Have you ever trained dogs?
Yes No

8. If yes, please describe the training methods used, commands taught, and	
 which methods you use to correct mistakes?
 

9. Please describe how you would deal with housebreaking, barking, chewing, leash aggression, 
separation anxiety or other training issues if you were to encounter 
them in your rescued dog?
 

10. Describe your familiarity with crate training, and if you are willing to 
consider the use of a crate as a housebreaking and transitional aid?


11. What type of research have you done to familiarize yourself with the traits of the
 German Shepherd breed?  Tell us about any books or other materials have you've read,
 if you've attended dog shows to meet German Shepherds, etc.



12. Please describe what you believe to be the good and bad points of the  
 German Shepherd breed, and what qualities about the breed make it the right	   
 choice for your home?


13. Number of people in household:
	Adults:   Children:  Children's' Ages: 

14. Number of hours a day will your dog be alone:
	

15. Where will your dog sleep?:
	

16. Where will your dog spend most time during the day?
	

17. How will your dog receive physical exercise?
	

18. Who will have the primary responsibility for the care and well being of your dog?
	

19. How would you describe your household activity level?
	 Very Quiet
	 Rather Easygoing
	 Usually Active
	 Lots of Activity

20. Estimate the number of times per month adults visit you home?:
	

21. Estimate the number of times per month children visit you home?:
	

22. In addition to a regular life at home, would your dog
(check all that may apply):
	 Walk routinely with a family member
	 Compete in obedience trials or other dog sports
	 Go to obedience classes.
	 Go to work with you.
	 Travel with you.
	 Be a playmate for your children or pets.

23. Do you live in a:
	 Single family home
	 Mobile Home
	 Condominium
	 Apartment

24. Do you rent?
	 Yes
	 No

If you rent or lease, you must have written permission
from your landlord prior to approval of your application. A letter from your landlord can be faxed to 619-501-9844.

Please complete landlord information:

Landlord's Name 
        Address 
           City   State  Zip 

25. Is your yard fully fenced?
	 Yes
	 No

If "Yes", please describe the size of the area, the height
and the type of fencing material:

If "No", would you fence all or part of the area
as a condition of adoption?
	 Yes
	 No

26. Are there any structures that would allow your dog to climb out
of this area? Any poisonous plants? A pool? Electrical meter or
unusual features?


27. Which dog/s are you interested in:

Dog's Name 

28. Which sex would you prefer?
as a condition of adoption?
	 Male
	 Female
	 No Preference

29. What age would you prefer?
as a condition of adoption?
	 Under one year
	 1 to 3 years old
	 Over 3 years old
	 No Preference

30. Occasionally, a dog with special needs
(physical restrictions or senior dog, for example)
is available for adoption. Would you consider such a dog?
	 Yes
	 No
	
31. Are you financially prepared to provide regular veterinary care?
	 Yes
	 No

32. Considering all dogs you have owned, what health issues have you
experienced and what kinds of routine veterinary care was given:


33. Do you currently have a veterinarian?
	 Yes
	 No

If "Yes", please complete your veterinarian's
contact information:

	Vet's Name:	
         Address:	
	      City:	
     Phone Number:	

34. May we contact your veterinarian?
	 Yes
	 No

	
35. Does anyone in the home have medical conditions or physical limitations

 that might cause difficulty in caring for or living with a large, strong dog?  
	 Yes
	 No

If so, please explain:

	Explanation 
	
36. When you go out of town who will care for the dog?
	Out of town 
	
37.  If you had to move for any reason, would you bring your dog with you?
	 Yes
	 No
	
	If no, please explain 
	
38. How did you find Southern California German Shepherd Rescue?


39. Please add any additional information or thoughts you feel
will help us find the right German Shepherd dog for you.