First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Cell Phone

Why are you interested in adopting a pet at this time?*

What is your and your spouse/partner (if applicable) occupation?*

What is the name of your partner/spouse?

What is your current age and if applicable age of your partner or spouse?*

Who will take care of the dog on a daily basis?*

List the age of any children living in the household:*

Please list name and breed of any dogs currently in your house.

Please list any other animals (cats, birds, horses, etc) that are currently living in your household (if any).

Please list name of any dogs that you have had over the past 10 years that are no longer with you.

Is there a particular dog you are interested in?

Please list the name and telephone number of your current veterinarian or prior veterinarian that you used.*

Please list two references (at least one that is not a family member) and a contact number:*

Do you own or rent your home*
Choose one: Rent Own

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Where will the animal be kept when you are home?*

Where will the animal be kept when you are not home?*

How much time will the animal spend alone during the day?*

We do NOT require a fenced in yard, however, we do ask just to get to know the property better. Is your yard fenced*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

Have you ever given up a pet? If yes, please explain*

Some German Shepherds are best as the only dog in the household. Are you willing to consider a dog that is people friendly but may prefer not to be with other dogs?
Choose one: Yes No

To help us track our reach to the general public, how did you hear about Sedona Shepherd Sanctuary?*

Have you applied with any other rescue*
Choose one: Yes No

Please tell us a little bit about yourself:*