LOUISIANA SHELTIE RESCUE

ADOPTION REQUEST

Name:________________________________________________________________________ Address:______________________________________________________________________ City:__________________________ State:_____________ Zip: _____Phone:_________

Employer: _________________________________ Work Phone: _________________ DriversLic.Number________________

Veterinarian reference (name, address & phone)______________________________________________

Your E-Mail____________________________________________________________________

Your age__________ (to be used in selection of appropriate dog)

1. Why do you want a Sheltie?________________________________________ ____________________________________________________________________

2. Have you ever owned a Sheltie before?________________________________

3. Do you still have that dog?______________________________________________

What happened to your last dog?_______________________________________

4. During the last two years: _______________________________________________

a. Have you lost a pet (not through death)?________________________________

b. Have you had one poisoned?_________________________________________

c. Have you had an animal killed by a vehicle?____________________________

d. Have you had an animal die due to disease?_____________________________

If yes, what did it die of ?______________________________________________

5. For what purpose do you want this dog?____________________________________

_________________________________________________________________________

6. Do you have any other animals? _____ List type, age, and sex __________________

_________________________________________________________________________

7. Do you have children at home? ____ Number: ________ Age(s):_________________

8. Do you live in a house? ______ Apartment?______ Condo? ______Trailer?_______

9. Do you rent or own ? __________________________________________________

10. If you rent, do you have the landlord's permission to keep a dog? _______________

11. Do you have a yard? ________________Is it fenced? ______________________

What type of fencing? _________________________________________________

12. Do all family adults work?___________ Is someone home during the day? ________

Please explain: ________________________________________________________

13. What provisions will be made for your Sheltie if nobody is home during the day? ____________________________________________________________________

14. Do you intend to keep this dog primarily indoor or outdoors? ___________________

Where will it sleep? __________________ Please explain: _____________________

__________________________________________________________________________

15. Do you have a sex preference? Male__________ Female___________________

16. Do you have a color preference___________________________________________

Second color choice:____________________________________________________

17.Would you consider: The opposite sex? ________ An older dog? _________ To what

age? _________ Littermates or a bonded pair? __________________

18.What size Sheltie do you prefer?____________________________________

19. Are other members of your household aware that you are considering adopting a pet?

_________________________________________________________________

20. Are you prepared to assume the financial responsibilities of caring for an animal, including inoculations, veterinarian care, good quality food, licensing,

etc. ?_________

21 Are you planning to move in the near future?____________________________

22. Is anyone in your house allergic to animals?_________________________________

23.Are you familiar with the animal control regulations in your area?_______________

24. Is this Sheltie going to be a gift? ____________ For whom________________

Do they know they are getting the gift? ____________________________________

25. Do you understand that any rescue animal that you may adopt through Louisiana

Sheltie Rescue will be spayed/neutered? _________________________

26.What circumstances, in your mind, justify getting rid of a dog?___________________

_____________________________________________________________

_____________________________________________________________________

27. What plans do you have if your pet outlives you?_______________________________________

28. Are you willing to allow a Rescue Representative member to visit your home by

appointment? _________________________________________________________

29. How did you hear about Louisiana Sheltie Rescue? _________________

____________________________________________________________________

30.Do you accept that there will be a $200 donation for each adopted dog, $275 for a puppy?________________

(Application continued on Page 3)

I am in full agreement with the Louisiana Sheltie Rescue. Terms of Adoption (attached), By signing below I am attesting to the truthfulness of my answers. I understand that falsification of any of the above information will be grounds to disallow the adoption of a rescue Sheltie.

__________________ ________________________________________

Date Signature

NOTE: If you are under 18 years of age, a parent or guardian must also sign this application. Thank you for considering a dog from Louisiana Sheltie Rescue If you have any questions, or if we can be of assistance, please do not hesitate to call.

We reserve the right to refuse any applicant.

Please return to: Sheltie Rescue of Louisiana

Phone:(985) 863-5845, Fax: 985-863-8956, E-mail : radandred@worldnet.att.net

web page: http://home.att.net/~radandred/lcsr.html

____________________________________________________________

Sheltie Rescue Official Use Only

Approved_______ Disapproved___________

Staff Member: ________________________________ Date __________

Comments: __________________________________________________

____________________________________________________________

Dog Adopted: ____________ Number: __________ Date: ___________

TERMS OF ADOPTION

1.Return: The adopted dog may be returned to Louisiana Sheltie Rescue within two weeks of the adoption for full refund of payment if the adopter is not satisfied with any aspect of the adoption. After two weeks from the above date, no refund will be given even if the dog is returned to Louisiana Sheltie Rescue.

2. Transfer of Ownership; The adopted dog may not be transferred to any other person for any reason. If the undersigned adopter is forced to relinquish custody of the dog at any time, said dog will be relinquished only to Louisiana Sheltie Rescue.

3. Refund: There will be no refund or reimbursement for any expenses incurred by the adopter for the adopted dog, even if it is returned to Louisiana Sheltie Rescue.

4. Health Program: The adopted dog will be cared for humanely, including adequate food, water, shelter, and veterinary care and will be licensed in accordance with the laws in the jurisdiction in which he resides. The dog is to be exercised in a fenced yard or on a leash and NOT TO BE FREE TO ROAM THE STREETS.

5. Reason for Adoption: The adopted dog is to be kept as a house pet; it shall not be used for medical or any other experimental purpose; it shall not be chained or tied, and it shall not be used for breeding.

6. Loss: If the adopted dog is lost or stolen, the adopter will notify Louisiana Sheltie Rescue within three (3) days.

7. Reservation of Rights: Louisiana Sheltie Rescue reserves the right to enforce this contract in order to protect the welfare of the adopted dog. It is understood that Louisiana Sheltie Rescue may examine and may make inquiry about said dog at any time. If the terms and conditions of the Adoption Agreement are not upheld, Louisiana Sheltie Rescue reserves the right to terminate the Agreement and to reclaim the dog.

8. Return Check Charge: There will be a $15.00 charge on all returned checks submitted by the adopter. If a check is returned from a banking institution, Louisiana Sheltie Rescue reserves the the right to reclaim the dog.