Application

Application for Adoption

Date * / MM / DD YYYY
Name * First Last
Age *
Occupation
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Nearest Big City
Phone(home) *
Phone(Cell)
Phone(work) *
Email *
Please check selections on all questions with multiple choices:
1. How did you hear about Shiba Rescue of Southern California?
National Shiba Club of America Member of Shiba Rescue Petfinders.com Friend/Family Member Other Rescue Organization Other
2. Why do you want a Shiba?
3. How familiar are you with Shiba Inu’s and other primitive breed dogs?
Owned/fostered before Friend/Family Member owns/fosters Read info online Not familiar, want to learn more Other
4. Who is this Shiba for?
5. Where do you live?

5. Where do you live? House Apartment Condo
6. Do you have plans to move?
If yes, please describe:
7. Do you have a fenced yard?
If yes, fence height:
8. The dog will stay:
Indoors Mostly Indoors Indoors/Outdoors Mostly Outdoors Outdoors Outdoors, including when I am not home
9. Do you have any children?
10. Please list the names and ages of all of the members of your household:
Name
Age
Name
Age
Name
Age
11. Do you have other dogs?
If yes, please list a name/breed/gender/age for each:
Name
Breed
Gender
Age
Name
Breed
Gender
Age
Name
Breed
Gender
Age
12. Does your dog get along with other dogs?
If no, please describe:
13. If you have had dogs in the past, what happened to them?
14. Have you ever had to give up a dog or other pet?
If yes, please describe:
15. Do you have any cats?
If yes, please list:
Name
Gender
Age
Name
Gender
Age
Name
Gender
Age
16. Do you have any other pets?
If yes, please list:
Name
Type
Gender
Age
Name
Type
Gender
Age
Name
Type
Gender
Age
17. Does everyone in your family/household want a dog?
If no, please describe:
18. Please provide a name/telephone number for a vet reference. If you don't currently have a vet, please provide a personal reference, preferably a pet reference (previous vet, a current or previous obedience instructor, a dog walking service, or the humane society for which you volunteer, etc.).
Name
Relationship
Phone - ### - ### ####
Name
Relationship
Phone - ### - ### ####
19. Do you rent or own?
If you rent, please provide the name and phone # of your landlord:
Name
Phone - ### - ### ####
20. If your housing association has breed/weight restrictions for dogs, please specify:
Breed Restrictions:
Weight Restrictions:
21. What dog breed(s) would you be willing to consider? (please check all that apply)
Shiba Inu (typically between 15-35 lbs) Shiba mix or Jindo mix under 35 lbs Jindo (typically between 30-45 lbs) Shiba mix or Jindo mix under 45 lbs Other primitive breed over 45 lbs (i.e. Akita, Kai Ken, Chow, Ainu Ken / Hokkaido)
22. What gender dog(s) would you like to adopt?
23. What age dog(s) would you like to adopt? (Please check all that you might consider, remember there are very few puppies in rescue)
Puppy (under 1 year) Young adult (1-3 years) Adult (4-7 years) Senior (8 years or older)
24. What color dog(s) would you like to adopt? (please check all that you might consider)
Red Red Sesame Black & Tan Cream
25. What activity level do you plan to maintain with your dog(s)?
Couch Potato Occasional Walks Daily Walks Running

Application

Application

Please check selections on all questions with multiple choices:

10. Please list the names and ages of all of the members of your household:

If yes, please list a name/breed/gender/age for each:

If yes, please list:

If yes, please list:

18. Please provide a name/telephone number for a vet reference. If you don't currently have a vet, please provide a personal reference, preferably a pet reference (previous vet, a current or previous obedience instructor, a dog walking service, or the humane society for which you volunteer, etc.).

If you rent, please provide the name and phone # of your landlord:

20. If your housing association has breed/weight restrictions for dogs, please specify: