Name: ______________________________

Address: __________________________________________________________________________________

City: _________________State: _______________ Zip: __________ Phone: ______________

E-Mail Address: ______________________________________________________________

Occupation: ________________________________________Work Phone: _______________

1. Why do you want a Shetland Sheepdog? _____________________________________________

_____________________________________________________________________________

2. Have you ever owned a sheltie before? Yes ___No ___
3. What happened to your last dog? ___________________________________________________
4. During the last two years:

Have you lost a pet (not through death)? Yes ____No ___

Have you had one poisoned? Yes ___No ___

Have you had an animal killed by a vehicle? Yes ___ No ___

Have you had an animal die due to disease? Yes ___No ___

If yes, what was the cause of death?   ________________________________________________________

5. For what purpose do you want this dog?  _____________________________________________________
6. Do you have any other animals? Yes ___ No ___ List types, age, and sex: ____________________
7. Do you have any children at home? Yes ____No ___ #: __________ Age: __________
8. Do you live in a house? ________ Apartment? ____ Condo? ____Trailer? ____
9. Do you own or rent?   ____________________________________________________________________
10. If you rent, do you have the landlord’s permission to keep a dog? Yes ___No ___
11. Do you have a yard? Yes ___No ___ Is it fenced? Yes ___No ___  If no, are you willing to fence it in? Yes___ No___
12. Do all family adults work? Yes ___No ___Is someone home during the day? Yes ____ No ____
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 indoors or outdoors?______________________________________
15. Where will it sleep? ________________________________Please explain:  ___________________________

    16. Do you have a sex preference? No _______ Male: ________ Female: ________

    17. Would you consider the opposite sex? Yes ___ No ___

    18. Would you consider an older dog? Yes ___No ___To What Age? _______

    19. Do you have a color preference? No _______ Color: _________________

                        Second Color Choice: __________________________________

    20. What size sheltie do you prefer? ________________________________

    21. Are other members of your household aware that you are considering adopting a pet? Yes ___ No ___

    22. Are you prepared to assume the financial responsibilities of caring for an animal, including inoculations, 

    23. Are you planning on moving in the near future? Yes ___No ___

    24. Is anyone in your house allergic to animals? Yes ___ No ___

    25. Are you familiar with the animal control regulations in your area? Yes ___ No ___

    26. Is this sheltie going to be a gift? Yes ___No ___For whom? _____________________

Do they know they are getting the gift? ____________________________________

    27. Do you understand that any rescue sheltie that you may adopt through KVSSC Rescue will be spayed/neutered?

                            Yes ___ No ___

    28. What circumstances in your mind, justify getting rid of a dog? _____________________________________

    29. Are you willing to allow a Rescue Representative member to visit your home by appointment?

                            Yes ___No ___

    30. How did you hear about KVSSC Rescue? _____________________________________________________

    32. Your Veterinarian's phone number:_________________________ 

    33. Do you accept that there will be a $200.00 fee for the adopted dog? Yes ____ No ____

I am in full agreement with the Kennebec Valley Shetland Sheepdog Club 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 ground to disallow the adoption of a rescue sheltie.

Date:______________________________________Signature:________________________________________

Date:______________________________________Signature:________________________________________

If you are under 18 years of age, a parent or guardian must also sign this application. Thank you for considering a dog from Kennebec Valley Shetland Sheepdog Club. If you have any questions, or if we can be of assistance, please do not hesitate to call.

Please return to: 

Cathy Small

108 Spears Corner Road

West Gardiner, ME 04345

               (or)

Holly Fent

66 Caleb Street  

Staff Member: _______________________________ Date: ________________

Comments: ___________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Dog Adopted: __________________________Number: ___________ Date: ________________