Todays Date:
January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2008
How did you hear about us:
Your Contact Info:

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Question or Comment:

What is your marital status? Married Single

How many adults in the home? 1 2 3 4 5 6

How many children in the home? 1 2 3 4 5 6 7 8 9 10

Do you currently own pets: Yes No

Does anyone in your household have any known allergies to dogs? Yes No

If yes please explain:

Have you ever turned an animal into the animal shelter? Yes No

Do you have a gender preference for you new German Shepherd? Male Female either

Do you have a color preference for you new German Shepherd? White Black Sable Black/Tan Any Color

Would you consider adopting or fostering a mixed breed German Shepherd? Yes No

Would you consider adopting or fostering a dog that has been abused? Yes No

Would you consider adopting or fostering a special needs or senior German Shepherd? Yes No

Veterinarian Information:

Do you currently have a veterinarian?: Yes No

How long have you used this vet?:

If you have used this Vet for less than one year please provide contact info here: If less than 6 months, please give previous Vetinarian Contant Information here:

Please click the Submit Button when you are finished!

If less than 5 years at your current residence or you are renting please provide Landlord Contact Information here including phone numbers.

Are there any restrictions for dogs such as number, size and breed in your community?

Do you have a fenced yard: Yes No

Is everyone in the household in agreement on

adding a dog to the family?

LabelHave you ever owned a German Shepherd before? Yes No

Please provide a brief history of your experience with a German Shepherd. Please give a brief history of your experience with the German Shepherd.

If you currently own a pet are they up to date on vaccinations and heartworm preventative? Yes No

Please enter the primary age desired for your new dog. less than 1 year No 1 year 2 years 3 years 4 years 5 years 6 years 7 years or older

How many hours daily will your German Shepherd be home along?

What is the longest duration that your dog will be left outside unattended?