updated February 2, 2008
Name of the dog(s) you want to be considered for?
 
Your name:
 
Address:
 


City,

Phone number:
  (h) (w) (c)
Email address:
 
How many people are in your household?
 

Total Children
Children's ages

Is everyone in your household in agreement to add a new pet?
  Yes    No
Is this pet for you and will you be the primary caretaker?
  Yes    No
If not explain who the dog is for and who is to be the primary caretaker:
 
Have you owned a German Shepherd Dog before?
  Yes    No
Do you currently own any other pets?
  Yes    No
Please list all current pets (names, species, ages, sex, are they spayed/neutered?
 
Please explain what happened to all previously owned pets and circumstances (i.e. died, gave away because, etc)
 
Do you have a preference as to the sex of your new GSD?
  No preference Male Female
Do you have a preference as to the color of your GSD?
  No preference Black & Tan White
What age range would you like to adopt?
  Puppy 1 -3 years 3 - 6 years 7+ years
Are you aware that GSD's grow big, like 55 to 100+ lbs?
  Yes    No
Do you know that GSD's have a double coat and shed a lot?
  Yes    No
Explain living arrangements and how this dog will fit in? (Inside, outside, both, etc).
 
Is anyone in your home allergic to pet dander?
  Yes    No
Regarding your residence, do you:
  Own   Rent Other
  If other please explain:
 
  If you rent are you allowed dogs 55-100+ lbs?
 

Yes    No
( You will be required to provide proof from your landlord.)

Do you have a fenced yard? Please describe (wood, chain-link, etc) including height.
 
Approximately how many hours will your dog be home alone:
  1-3 hrs 3-6 hrs 6-8 hrs 8-12 hrs 12+ hrs
If more than 6 hours what provisions will be made for the dog to relieve itself and get exercise in your absence?
 
Please list current Vet or one you have used in the past:
 

Name:
Address:
Phone #:

If you currently own a dog is your dog on Heartworm preventative? If not explain:
 
Are your pets current on their vaccinations?
  Yes    No
References: 3 personal references other than your Vet who are NOT related to you. (name, address, phone number).
 
Have you or anyone in your household ever been convicted of animal abuse/cruelty?
 

Yes    No
If you answered "Yes" please explain:

As part of the adoption process and before placing any dog, you will be asked to sign a contract in which you agree to certain conditions, such as allowing a WPGSDR agent to visit your home prior to and after placement of the dog, and surrender to WPGSDR the dog if you violate the contract or are unable to keep the dog for any reason.
   
Are you willing to take the dog to obedience classes? (Required)
  Yes    No
Are you willing to be bound by such a contract?
  Yes    No

If you do not wish to complete the form online you may
download the form and fill it out. Please mail or fax the completed form to:

Nancy De Moulin • 1331 Bellevue St. #299 • Green Bay, WI. 54302
Fax: 920-465-7796