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Rescue Links:
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Adoption
Application
E-Mail
this application to:
Central
Illinois Sheltie Rescue Please note that we have the
right to refuse any applicant.
Cut
& paste directions: (Win9X, 2K or XP) Place
your mouse pointer anywhere on this page. Right click one time. (right
button on your mouse) choose "select all". Then, right
click again, and choose "copy". Then open your e-mail editor, or a
word processing program. When you have the blank document ready that you
want to paste this into, place your mouse pointer in the blank space, and click your mouse
one time to make sure the cursor is IN the document. Then right click again,
only this time choose "paste".
1) Personal Information
I have read the "Adoption Information Page Yes No
Name:
Address:
City
State
Zip
Phones: Home
( )
Work: ( )
Employer:
Your date of birth: (mm/dd/yyyy)
May we call you at
work?
E-mail address:
Do you check e-mail every day?
**Name of dog(s)
you are applying for?
Have you submitted an application with any other rescue group ?
Please tell us which statement describes you best:
____ I want to adopt a Sheltie that has special needs. I really enjoy rehabbing and helping the needy dogs.
____ I want to save a Sheltie's life by adopting a Sheltie that no one else may want.
Why do you want to
adopt a rescue sheltie?
2) Sheltie Habits
Have you ever owned
a Sheltie before?
Are you aware of
all a Shelties needs and habits? (i.e. regular grooming, exercise)
Are you aware that
Shelties are "barkers"? (doorbell, UPS man, mailman, strangers etc
etc)
Are you aware that
a Sheltie is a longhaired, double-coated breed, that WILL SHED?
Are you aware that
Shelties may be somewhat shy around new people, and may take awhile to bond with?
Are you aware that
because of their shyness, Shelties are a high runaway risk during the first month?
3) Your Home
Who lives in your home?
Please list ages of
every person living (even part-time) in your home:
What is the speed
limit of the road you live on?
Do you live in a:
(circle one) House Apartment
Condo Other
Do you own or rent?
If renting, does the landlord allow pets?
Where will this dog be allowed to play and eliminate/potty ? Front yard? Back yard? Both?
Is either yard securely
fenced, with no holes or gaps, on all sides so that a small animal could not escape?
Describe the
material and height of your fence?
Does a door from
your house open directly into the fenced yard?
Are you planning a
move in the foreseeable future?
If you were to
move, would you insist on a new house having a fenced yard?
IF you were to
move, what would happen to this dog?
______ I would give the dog back to CISR
______ We would take the dog with us no matter what
______ We would try and find the dog a home
______ Depends on circumstances
How will this dog
be allowed to relieve itself daily?
_____ I will walk
it on leash
_____ I plan on training this dog to stay in my yard
_____ I have a "tie-out" trolley or stake.
_____ Other explain: _______________________________
How will you allow
this dog to run and get exercise?
_____ I will walk
it on a leash for _____ miles every day.
_____ I have a large yard the dog can run in.
_____ There is a large park or field nearby.
_____ Other: _____________________________
4) Your Pets (past and present)
Please tell us about your past and
present pets.
Breed?
- Sex? - Fixed? -
Dates owned - What
happened to pet?
If any of your
present or past pets were not spayed or neutered, please explain why?
Will you agree to
keep all of your current pets and your new Sheltie:
·
Up
to date on all shots?
·
On
heartworm prevention medication?
·
What
brand? ___________________
·
On
flea prevention medication?
·
What
brand? __________________
· Licensed in your county?
Name, address and
phone number of your Vet:
Please circle one: My vet may or may not be used
as a reference.
How often do your
current dogs get groomed?
Who is your
groomer?
5) Your Dog Care Knowledge
What
are heartworms?
Are you aware that Shelties (as a breed) have high maintenance teeth and will need dental cleanings by your vet frequently? (possibly yearly)
What symptoms would you likely notice if your dog had a decayed or infected tooth?
What symptoms would you likely see if your dog had worms?
What symptoms would you likely notice if your dog had an ear infection?
What is one of the first signs of illness in a dog?
IF you
have a gut feeling that something is wrong with your dog, but your Vet doesn't
seem concerned -- what would you do?
6) Daily Schedule
Do all adults in
the house work away from home?
Will any adult be
home during the day with the dog?
Specifically, how
many hours will this dog be home alone daily?
Where will this dog
stay while home alone?
_____ loose in
house
_____ outside
_____ crate
_____ X-pen
_____ kitchen
_____ basement
_____ other: explain: _____________________________
Please check all
that apply in your home:
____ Busy household
- visits by friends, children, parties
____ Noisy - TV, stereo, machinery, tools, children playing
____ Moderate - normal comings and goings
____ Quiet - "homebodies" few guests, stay home a lot.
____ Lots of children in the neighborhood
____ Live on busy street or highway
Where will this dog
spend most of its time?
______ outside
______ inside
______ outside during the day and inside at night
______ outside and in garage
Are dogs allowed in
all rooms of your home? Explain:______________________________________
Where will the dog
sleep at night?
Are dogs allowed on
your furniture?
7) Your preferences
Do you have the
time and or patience to housetrain a dog, if it is not already trained?
Would you be
willing to take a "special needs" (scared, shy, handicapped, or needs
medication) dog?
Would you be
willing to work with a "behavior problem" dog?
Would you be
willing to take an older dog?
Up to what age?
Do you have a color
preference?
Do you have a sex
preference ?
Will you take the opposite sex?
Do you have an age
preference?
Do you have a size
preference?
Do you have a personality preference? (ie…Couch potato, Frisbee dog, jogging partner,
quiet companion, etc.)
Explain:________________________________________________________________________________________
Please put the
following in order of importance to you:
I want my new sheltie to:
_____ play with my
other dog
_____ play with my children
_____ go walking or running with me
_____ be affectionate and cuddly
_____ be a good watch dog
_____ become a performance dog (agility or flyball)
_____ be trained and shown in obedience
_____ be very laid back and calm
_____ have lots of energy and exuberance
_____ be totally housetrained
_____ not be shy with strangers
_____ Other: __________________________________
Is there any quality in a Sheltie that you do NOT want ???
8) Your Commitment
Are you aware of
the financial responsibilities of dog ownership….(vet care, medications, food,
licensing, shots, grooming…etc?)
AKC reports it
costs on average $1000 per year to properly care for a dog, will this fit into your
budget?
Are you aware of the benefits of
using a premium quality dog food (no generic or grocery store brands) for your sheltie ?
Please list 2 of
the benefits:
IF your Sheltie were
to get loose and run away, because this breed is so shy..... it could take $1000's of
dollars in posters, ads in newspapers, and rewards, to find it. Were you aware of this, and would you
go to these lengths?
Check any of the
following circumstances that would cause you to give this dog back to us?
(Check any/all that apply)
____ a new job
(working more, longer hours)
____ kids getting busy, no time for
____ divorce
____ moving to a new house
____ new baby
____ if the dog needed expensive vet care
____ bad habits (potty accidents, chewing, destruction)
____ if it bit someone
____ other (please ______________________________
Are you aware that ALL dogs, just like people, WILL sometime in their
life need surgery, blood tests, medications and other medical procedures that
can be costly ?
Is there any reason that you would not choose to give expensive care to your dog
if it needed it??
9) Fee's
Are you aware of
the fees that our rescue organization charges ?
o
Puppies up to 1
year old........ minimum donation $ 325
o
Adults
1-9.......... minimum donation $ 225
o Senior Adults 10+.......... minimum donation $ 150
Your adoption fee
allows us to provide the following services to all dogs in our program:
·
All fee's includes:
- Spay or neuter (even on puppies)
- One year rabies shot
- DH2PP (Distemper/Parvo combo shot)
- Bordetella Shot (Kennel Cough)
- Heartworm Test (and treatment if positive)
- Heartworm Prevention
- Flea prevention treatment
- Wormed
- Groomed
- Dental cleaning
- Treatment of any medical issue
- Blood workup if indicated.
- Avid Microchip and registration form
- A medical history record comes with each dog.
Are you aware that
the next step in becoming approved, is for someone from rescue to come out and meet
with you and your family?
How are you
planning on getting this dog to you? (We don’t ship our dogs)
We do our very best to get back to
applicants in a timely manner. However, we cannot possibly contact everyone,
therefore only those applicants who are chosen
for this Sheltie will be contacted. If you are not contacted within a
week's time, please assume you were not chosen as the right home for this
particular Sheltie. This does not necessarily mean you were denied for adoption,
just not approved for this particular Sheltie. Feel free to contact us via email
for any questions/concerns you may have on an additional Sheltie we may have for
adoption. We appreciate your patience!
Time Frame: Please note that a home visit is required and depending on
where you live, the time frame may vary. We do our best to send out
someone asap, however some smaller rural towns may take more time.
All of the answers
I have given, are true and correct to the best of my
knowledge. I also understand that if any of my answers are
shown to be false at a later time, that the adoption contract will become null and void,
and I will immediately return the Sheltie to Central Illinois Sheltie Rescue.
________________________________
_____________________________
Signature of
applicant
Date
Please check to be
sure all questions are answered. Incomplete applications
are not accepted.
Please note that we
have the right to refuse any applicant.