City, State, Zip
Daytime Phone Number (include area code)
Evening Phone Number
How long have your worked for this employer?
Your Home and Family
How many adults in the home?
How many children in the home?
Please list any step-children, grandchildren, or other children who visit your home on a regular basis, along
with their ages.
Do all the family members want a dog?
What type of home do you live in?
Do you own or rent your
Do you have a fenced yard?
Height and type of fence
List any current pets, including their species, age, and gender.
List any former pets you've had in the last 10 years, and what became of them.
Have you ever been investigated for animal cruelty?
If yes, please list the city, county and state in which the investigation took place, as well as the details
of the event, and the disposition of the investigation (no finding, prosecution, guilty plea, etc.).
Veterinarian or Vet Clinic Name
Vet's Phone Number (include area code)
When did you use this vet, and with which pets?
Personal References (no family member reference allowed)
Name Reference #1
Relationship to Reference #1
Name Reference #2
to Reference #2
Interest In Adopting A Dog
Why do you want a dog?
Does everyone in the family want a dog ?
Please explain in detail your idea of the dog that would best fit into your home and lifestyle.
Is there anyone in your home who might be adversely affected by a dog (allergies, phobias, etc.)?
Care and Training
Who will be primarily 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?
Will the dog have the run of the house?
Will the dog be tied outside and/or confined to the yard?
Do you own a crate (kennel, dog carrier)?
Describe any previous dog training experience.
Will you take your dog to obedience training?
How will you discipline your dog?
How will you exercise your dog, and what activities will you share?
What will you do with your dog when you go on vacation?
In the event of having a child/more children, will you keep the dog ?
If you must move, what will you do with your dog?
Are you prepared to be responsible for this dog for 10 years or more?
Are you aware that costs for caring for a large dog will exceed $600 per year? (vet, licensing, food, toys, training,
What heartworm preventative will you use? (required for adoption)
What steps will you take to control fleas? (fleas are dangerous to your dog's health)
We require that all dogs be spayed or neutered prior to adoption, or that a spay-neuter deposit be payed, and proof
of operation submitted by you. Do you have any questions about this policy?
If you become unable to care for your dog for any reason, who will accept responsibility for its care?
In what type of vehicle will you transport your dog(s)?
If using a truck, where will the dog(s) ride?
Do you object to a homecheck conducted by one
of our members ?
We like to follow up on the welfare of our adopted dogs. May we call you or visit?
Your Doggy Preferences
If you are interested in one of the dogs on our site, which one?
If you don't see a dog here for you, please give us some information on what you might be looking for.
Do you have any special needs or preferences with
regard to the dog?
How did you hear about CenTex GSD Rescue ?
If you remember the name of the group, website, or person who referred you, please let us know who it was.