First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Work Phone
x

Cell Phone

Alt Email

Best time to call:*

Have there been any substantial changes to your home since your previous adoption such as new pet, new child, new roommate, etc?*

Do you have children that will be in contact with this dog?

Ages:

Do you own or rent?

Landlord's Name & Phone #: (Please enter N/A if you selected own.)*

Do your covenants / regulations have any restrictions against large breeds and/or GSDs?

How many dogs are you permitted to have based on local city/county zoning ordinances?*

Please list the name(s) of your VGSR dogs [tag number and adoption date, if known]:*

What other pets are in your household who will be in contact with the dog you adopt [once you are approved]? (Type / sex / age for each)?*

Is every dog / cat neutered or spayed?

If no, please explain why:

Will you give your VGSR dog Heartworm Preventative?

Please list all veterinarians, including mobile clinics, Names, Addresses and Phone Numbers, that have provided care for your previous
[in the last 3 years] and current pet[s].

By providing this information, you are authorizing a veterinary reference check by a VGSR representative.

Vet Name / Phone / City & State:*

Would you be willing to let a representative of VGSR visit your home by appointment?

Would you like to receive emails concerning VGSR events?

Name of dog(s) you are interested in:*

Providing this information does not guarantee adoption of any specific or requested dog. The foster of each dog will make the final decision to determine if a prospective home would be the best placement for their foster dog.

I/We have read and carefully answered each question on this Adoption Application and have provided truthful answers. I/We understand that VGSR will rely on the answers I/we have provided in going forward with the adoption process and, in the event that VGSR learns that false information has been given, I/we may be denied the right to adopt a dog and/or any dog placed in our care by VGSR and may be required to be returned to VGSR and all fees paid by us to VGSR will be forfeited.

I hereby certify that I have never been convicted of animal cruelty, neglect, or abandonment (all parties must sign):

Applicant's signature:*

Applicant's signature: