OWNER REFERRAL APPLICATION
The following documents must be presented to a GSGSR volunteer prior to the temperament evaluation:
• A copy of the dog’s Rabies Certificate and proof of Distemper vaccination.
• A copy of a bill or other document showing that the dog is on heartworm preventative. If the dog is not on heartworm preventative, the dog must be heartworm tested prior to adoption at the owner’s expense.
• Proof of ownership. This can be registration papers, a copy of the purchase receipt, a copy of the dog license receipt, or copies of veterinary records.
We require a non-refundable $25.00 processing fee with your application. We will not start processing your application until the fee is received. Upon completion of the application, you will be transferred to a web page with information about our processing fee.
Owner's information
Owner's name:
Address:
City:
County / State:
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Atlantic, NJ
Bergen, NJ
Burlington, NJ
Camden, NJ
Cape May, NJ
Cumberland, NJ
Essex, NJ
Gloucester, NJ
Hudson, NJ
Hunterdon, NJ
Mercer, NJ
Middlesex, NJ
Monmouth, NJ
Morris, NJ
Ocean, NJ
Passaic, NJ
Salem, NJ
Somerset, NJ
Sussex, NJ
Union, NJ
Warren, NJ
Zip:
Email Address:
Daytime Phone:
Evening Phone:
Other Phone:
Best time to call:
Why are you placing your dog?
By what date must your dog be placed?
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Veterinarian information
Veterinarians name:
Address:
Phone number:
Dog's information
Dog's Name:
Sex:
Age:
Date of birth:
Spayed/Neutered:
If not spayed, last heat cycle:
Color:
Approximate Weight:
How long have you owned your dog?
Where did you get your dog?
At what age?
Is your dog housebroken?
Crate trained?
Is your dog on Heartworm preventative?
If yes, what brand?
Next dose due:
Date of last Heartworm test:
Is your dog currently taking any medications?
If yes, list medication, frequency given, and reason prescribed:
What health problems/allergies does the dog have, if any?
Has your dog had formal obedience training?
What commands does your dog know?
How well does your dog walk on leash?
What toys and games does your dog like?
Where does your dog spend his days?
Where does your dog spend his nights?
How many hours is the dog home alone per day?
Is your dog allowed on the furniture?
Is your dog allowed on the bed?
Has your dog been raised with children?
If yes, what ages?
Please rate your dog’s behavior in each of the following areas as Excellent, Good, Fair, or Poor. Elaborate when necessary.
Please be objective – the better we understand your dog, the better our chances are of locating an appropriate adopter.
Children:
Other dogs:
Cats:
Strangers:
Being alone in the house:
Riding in the car:
Thunderstorms / Fireworks:
What do you feed your dog:
How many meals a day and at what times of day:
Can you take food and treats out of your dog’s mouth?
If no, please describe the dog’s reaction:
Can you touch your dog while he’s eating?
If no, please describe the dog’s reaction:
Can you take toys out of your dog’s mouth?
If no, please describe the dog’s reaction:
Does your dog dislike any class of people? (i.e. uniform, men, etc.)
Has your dog ever bitten anyone?
If yes, please explain:
What is special, interesting, and endearing about your dog?
What habits or unusual behaviors should potential adopters be aware of?
How are you paying for the application processing fee?
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Check
Paypal
I,
hereby make available for referral through Garden State German Shepherd Rescue, Inc. (GSGSR), a dog named
.
I understand that information pertaining to my dog will be posted on the Internet, and will be included in a listing of dogs available for adoption that will be presented to approved adopters interested in adopting a German Shepherd Dog.
I understand that my dog must be temperament tested by a representative of Garden State German Shepherd Rescue, Inc. (GSGSR) before being accepted into the Owner Referral Program. I understand and agree that GSGSR, Inc. may contact myself, my veterinarian, and/or breeder for additional background information on the Dog.
I understand that the final decision regarding with whom to place my dog is mine. I certify that I am the owner of this dog, and that the information provided herein is true and complete. Further, I hereby forever release, discharge, and agree to indemnify and hold harmless Garden State German Shepherd Rescue, Inc., its members and representatives, against any and all claims, known or unknown, now or hereafter, from all claims in connection with the adoption of, or any other disposition of, the above named dog.
I understand that my electronically-generated signature below is valid as a means of legal signature for the purpose of this Owner Referral Application
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YES
NO
Signature of Owner:
Signature of Owner:
Date: