| Date of Application | |
| IP Address | |
| First Name | |
| Last Name | |
| Street Address | |
| City | |
| State | |
| Zip | |
| Home Phone | |
| Work Phone | |
| Cell Phone | |
| Fax | |
| Email | |
| Occupation | |
| Hours | |
| Spouse/Partner Name | |
| Spouse/Partner Occupation | |
| Please list the ages of children living at home. | |
| List any allergies of home occupants. | |
| Referred by | |
| Veterinarian (include contact) | |
| Do you own or rent your home? |
Rent
Own
|
| Is it a single family, condo, or apartment |
Single Family
Condo
Apartment
|
| Do you have fencing? |
Yes
No
|
| What type of fence? Include material, height, and size of fenced area | |
| Is the fenced area attached to the house? |
Yes
No
|
| Does the fenced area have a door leading into the house? |
Yes
No
|
| Are you willing to comply with TOES fencing/leash policy? |
Yes
No
|
| Is someone home during the day? |
Yes
No
|
| Are you willing to take the dog to obedience class? |
Yes
No
|
| Indicate preference for gender of the dog. |
Male
Female
No Preference
|
| What age range would you prefer? |
Under 3
3-5 years
Over 5 years
No Preference
|
| When are you available for a personal interview? | |
| Would you consider taking a pair of dogs at once? |
Yes
No
|
| Would you consider being a "foster-to-adopt" home? (You become a foster home with the first right to adoption should your home and the dog prove a good fit. Often this can mean short-notice to travel and collect a dog. TOESR reimburses expenses and all necessary medical treatments) |
Yes
No
|
| Have you ever owned an Old English Sheepdog before? |
Yes
No
|
| Have you ever owned a dog before? |
Yes
No
|
| Have you ever lost a dog? |
Yes
No
|
| Has one of your dogs ever been killed or injured? |
Yes
No
|
| Please list your previous dogs along with how they came to you, how long they lived with you, and what became of them (did they pass due to age, etc) | |
| If you currently have other animals, list type, age and sex (please include all animals in the household, not just dogs). | |
| Is there a dog in our program at this time that has sparked your interest? | |
| Why do you want an Old English Sheepdog? | |
| Where will the dog be kept during the day? | |
| Where will the dog be kept at night? | |
| How many hours will the dog have to be alone? | |
| Any further comments? | |
|
