Adoption ApplicationStep 1 of 812%This application was designed to help us get to know you and to help you find the right dog for your family. If some of the questions seem personal, that's because the more we know about you the more confident we will feel considering you to adopt one of our foster dogs or referring you to a dog available elsewhere. Please feel free to ask questions of your own.If you’re applying to adopt a specific foster dog from NYCSR, please list their name here, along with why you feel this is the right dog for you or your family.PERSONAL INFORMATIONName:Date of Birth:Street Address:City, State ZIPPhone:WorkCellEmail:Residency Information:How long have you lived there?Do you own the property or are you renting?If renting, does your landlord allow dogs?If yes, can you get it in writing upon request?Do you have plans to move?If yes, when and where?Do you have a fenced yard? (Yes / No)If yes, fence material and height?If no, are you planning to fence??Do you have a crate?If no, are you willing to buy a crate?Are you willing to crate train if needed?Will you allow a home visit by rescue personnel upon request?Family and Friends:Do you have other adults living with you? If so, please list them.Who will be the primary caretaker of the dog?Do you have children who live with you or visit your home on a regular basis? If so, please list their first name and ages.Are the children experienced around dogs?Is anyone in the home allergic to dogs?Is anyone in the home afraid of dogs?Does everyone in your family want a dog?Professional Information:What is your occupation?How far from home do you work?How many hours per week do you work?Other adult in household’s occupation?How far from home do they work?How many hours per week do they work?Budget and Finances:Do you feel you are financially and physically able to care for a dog for its lifetime?Are you willing and able to consider a “special needs” dog?Other Pets:Have you ever owned a dog(s) before?If so, How many?What were their breed(s)?What happened to them if don’t still have them?If they have passed away, please explain how?Do you currently have any other pets?If yes, what kind(s)? (please list breed, gender, age and describe each temperament)Are current pets up to date on all vaccinations and preventative care?Are they spayed/neutered?Do you anticipate any potential problems with your current pets and your new dog?If so, how do you plan to overcome the problems?About Your New Dog:Why do you want to adopt a dog?Who is this dog for?Why do you want a Shiba Inu in particular?What do you know about the Shiba Inu breed?Where did you learn about the breed?Have you discussed with your family the pros and cons of owning a Shiba?What other breeds have you been considering?What age range are you looking for?Why?Do you have a preference for male or female?If yes, why?Do you have a color preference?Are you willing to consider a Shiba MIX or only a purebred dog?How far are you willing to travel to meet/pick up your new dog?Are you willing to adopt a dog sight unseen?If so, can you pay travel expenses for the dog to get to you?Your New Dog’s Environment, Socialization and Training:Will the dog be in contact with any other pets outside your home? (Please explain)What do you expect your daily routine to be with your new dog? (Please describe)How much time will be spent with your dog daily on weekdays?How much time will be spent with your dog daily on weekends?How many hours will your dog be left alone daily?Where will your dog be when you work?Where will your dog sleep?Will your dog be crated or restrained?If restrained, will your dog be tied or staked out outdoors?Is your lifestyle such that friends, relatives and children gain admittance to your home, property, and/or car without your supervision?How often will your dog be walked?Where, how and by whom?How often will your dog be played with?By whom?Who will care for your dog if you are away overnight or on vacation?What are your training objectives? What kind of work or behaviors do you expect of this dog?What amount of time and effort do you expect to devote to training him/her?Which family members will be expected to assist with home training?Will you take your dog to obedience training classes?Have you chosen a trainer or school? If so, who?:What is your definition of disciplining a dog?Describe two pet behavior problems that you have worked through and how you solved the problems:Are there any unusual circumstances to which your dog will need to adapt?Do you have any other comments regarding your daily routine?Who is the Veterinarian that will be caring for your dog?Clinic Name:Vet's Name:PhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country References (MANDATORY)Please list two personal references. If possible, please list individuals who are active in the dog community and are knowledgeable about your care of dogs, such as a trainer, veterinarian, breeder, active rescue volunteer, etc. DO NOT LIST FAMILY MEMBERS.1st Name First Last PhoneEmail2nd Name First Last PhoneEmailPlease feel free to add any other information you think would be useful for us to know or make any comments that you would like to add.STATEMENT OF UNDERSTANDINGThe information I have provided in this document is correct and true to the best of my knowledge and I have not withheld any pertinent information. I understand that any misrepresentation of me or my family or any untruths of the information I have provided herein that are discovered at a later date will invalidate any adoption agreement and will give the rescue the right to reclaim the dog without my permission and without refund of any adoption donation. Submittal of this form provides my agreement to this adoption application.Signed:Date:Name (Printed):
