Puppy Pre-Adoption Application

NAME (first & last):*
email address:*
address (Street, City, State/Province, ZIP):
home phone:*
work phone:

What is the best method to reach you?
email home phone work phone

How did you hear about us?

Please take your time answering the following questions. We ask that you answer all the questions with as much information as possible.

1. In what type of housing do you reside?
single family home condo duplex apartment 1-5 acres farm/ranch > 5 acres

2. If you rent, does your landlord permit dogs?
yes no

3. Would you permit us to contact your landlord?
yes no
Landlord's name and phone number...

4. Do you have a fenced in yard?
yes no
If yes, type of fence and height of fence (in feet):
If not, are you able to leash walk your dog at least 4 times a day for necessary functions and exercise?
yes no
If the answer is no, why not?

5. Tell us the number (each) of adults and children, in addition to how many do gs, cats, birds, or any other pets that make up your family (i.e. 2 adults (include their ages), 3 children (include their ages), 1 dog (inlcude age, sex, breed, if spayed/neutered))

6. How many dogs have you owned? over the course of how many years? (i.e. 1 dog, the last 10 years)

7. My dogs were:
given away killed in accidents died of old age euthanized (details below) other circumstances:

8. Does anyone in the household have allergies?
yes no

9. Do you have a person living in your household that is... (select all that apply ctrl+ click):
elderly handicapped special needs

10. I am interested in a pet and plan to spay/neuter:
yes no

11. I am interested in showing and/or breeding:
yes no

12. I am interested in training my dog in the following (select all that apply ctrl+ click):
obedience agility search & rescue schutzhund herding therapy other, describe below

13.My dog will spend most of his/her time:
in the house in the fenced yard in a kennel run on a chain running loose other, describe below

14. I would like a:
plush smooth either would be great

15. I would like a:
male female either would be great

16. I would like a:
sable dual/bi pattern solid white solid black no preferance

17. How many hours a day would the dog be left alone each day?

18. Are you willing to crate train your Shiloh, if necessary?
yes no

19. Do you agree to return your Shiloh Shepherd to us if you are unable to keep it or any reason?
yes no

20. Are you willing to keep the dog up to date on all of its shots, screen for heartworm and use heartworm preventative?
yes no

21. Are you willing to screen your dog for heart and eye defects?
yes no

22. Are you willing to have your dog seen by a vet at least once a year?
yes no

23. Are you willing to have the dogs hips x-rayed and rated (OFA or PennHIP) after the age of 24 months and provide us with the report?
yes no

24. Are you willing to license the dog and keep it properly identified?
yes no

25. Are you willing to pay shipping charges for this dog?
yes no

26. Please list three references (two if you have a current veterinarian). Please include complete name, address and telephone number for each reference.

27. How did you come to the decision to want a Shiloh Shepherd in your life?

28. Describe the temperament you’re looking for. For instance: Do you want an active dog? Do you prefer a quiet dog? Smart? Sweet? Faithful? Funny? Do you want a problem solver? (Hint: Some of them can open refrigerator doors and unlock locks.) Let us know what you’re hoping for so we can find a good match.

additional comments:

There is a $500.00 fee that will reserve your pup for you. This fee will apply to the purchase price of $1550.00 (Pet companion with a spay/neuter agreement) $1800.00 (upgradeable breed potential) and $2500 (show/breed with puppy back agreement), which will be due at the time of puppy delivery or pick up. The deposit is non refundable unless a puppy is not available, or it is determined by Rain City Shilohs that there is no suitable puppy at this time.