Name ___________________________________________________

Address______________________________  City/State ___________________ Zip ________

Home Phone __________________________    Cell Phone _____________________________

Email ________________________________

Your current employer _______________________________

Current or prior Vet Clinic for reference (include name/address/phone)

______________________________________________________________________________

Are you over eighteen years of age?   YES    NO

What are your reasons for wanting a dog?____________________ _________________

______________________________________________________________________________

Have you researched the GSP Breed?   YES    NO

Why have you chosen to get a GSP through rescue? ___________________________

______________________________________________________________________________

Have you applied to any other rescue group within the past 6 months? If yes, please list them.

______________________________________________________________________________

Have you owned a GSP before?   YES    NO

Do you currently own a GSP?   YES    NO

What other breeds have you had? __________________________________________________

Are you looking for: (Check ALL that apply)   ___Family Pet   ___ Hunting Companion  

      ___Indoor Dog    ___Outdoor Dog     ___Younger      ___Older

Do you prefer male or female?   Male   Female   Either

If you have a preference of male/female, please explain why: 

_____________________________________________________________________________

What activity level do you expect or want in a dog?  

      ___Very high   ___High   ___Moderate  ___Mellow

What traits are you looking for in a dog? ____________________________________

_____________________________________________________________________________

Will you obedience train your dog?   YES    NO

Are you willing to attend obedience classes with your dog?   YES    NO

If you do NOT intend to train, please explain why: ___________________________

_____________________________________________________________________________

Have you ever obedience trained a dog before?   YES    NO

Do you intend to crate-train your dog?   YES    NO

If "no" or "not sure" for crate training, please explain why: 

______________________________________________________________________________

How far are you willing to travel to meet and/or get your dog? __________________

What is your time limit for finding the right dog for you? (Check ALL that apply)

      ___One week    ___One month    ___6 months    ___One year     ___No limit

Please list ALL CURRENT pets (include cats, birds, hamsters, fish, etc.), their sex and age(s).

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Are your current pets spayed or neutered?   YES    NO

Have you ever given a pet away, taken a pet to a shelter, or returned a pet to is breeder? If yes, 
please describe the circumstances. _____________________________________________

______________________________________________________________________________

Who will be the dog's primary caretaker? _______________________________________

Who will care for your pet during vacations? ___________________________________

Do you rent or own your home?   OWN    RENT

If renting, do you have permission to own a dog?   YES    NO

Are you planning on moving within the next year?   YES    NO

Do you or does anyone living in your home have allergies or asthma?   YES    NO

Are there children in your home?   YES    NO

If there are children, what are their ages? ______________________________________

What other adults live in your home? _______________________________________________

Are all of the adults in the home supportive of adopting a rescue dog?   YES    NO

Do you have a dog proof fenced yard?   YES    NO

How large is the yard? How high is the fence? What type of fence? 

______________________________________________________________________________

If no fence, are you willing to install actual or electronic invisible fence?    YES    NO

Is someone home during the day?   YES    NO

Will someone take time off work when the dog first comes?   YES    NO

How much time will the dog spend alone? Where will he/she be during that time? 

______________________________________________________________________________

Where will the dog live? _________________________________________________________

Where will the dog sleep? (Check ALL that apply) 

      ___Crate    ___Dog Bed    ___Family member’s bed    ___Basement    ___Garage   

      ___Fenced Yard      ___Outside shelter     ___Kennel     ___Doghouse

What activities would you like to do with your dog? 

______________________________________________________________________________

Are you willing to give the dog at least 6 months to adjust to you, your family and his/her new 
environment?   YES    NO

Would you be willing to allow us to visit you and your new dog after the adoption?   YES    NO

Do you intend to be a single or multiple dog family?   ___Single     ___Multiple

Are you interested in any dogs currently featured on our web site? List names and briefly explain your 
interest in that dog? _________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

List the types of behavior problems you consider NOT acceptable: 

______________________________________________________________________________

Are you aware of the annual cost of proper care for a healthy dog in your area?   YES    NO

Will you deal with health issues, should the dog need special care later in life?   YES    NO

What would you consider the health limitations to be? 

______________________________________________________________________________

For what reasons would you ever give up a dog? 

______________________________________________________________________________

______________________________________________________________________________

Anything else you think we should know in order to help us match you with the right GSP?

______________________________________________________________________________

______________________________________________________________________________

Signature _____________________________________________

Print Name ___________________________________________      Date _________________

MAIL COMPLETED FORM TO: Cindi Chilbert, 14221 GAR Hwy., Chardon, OH 44024