Shiba Inu Rescue of Florida Adoption Application

SHIBA INU RESCUE OF FLORIDA

Adoption Application
SIRF is an all-volunteer, non-profit, animal welfare organization dedicated to the rescue and placement of stray, neglected and abused animals. SIRF is completely funded through fundraising efforts and public donations. All of our pets are cared for by foster homes and receive complete medical care, which includes worming, vaccinations, spaying/neutering and microchipping prior to their adoption.
This questionnaire is designed to help SIRF and yourself determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. SIRF reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions!
Applicant Information
Your full name:*
Your age:*
Street Address:*
City*
State*
Zipcode*
Home Phone:*

Area CodePhone Number
Work Phone:

Area CodePhone Number
Cell Phone:*

Area CodePhone Number
E-mail:*
Employer:*
What is your occupation*
How far do to live from your work *
How many hours a week do you work*
Character reference name and phone number:*
Character reference name and phone number:*
Household Information
Are all members of your household in agreement with this adoption?*

YesNoDon't Know
Who will be the pet's primary caregiver?*
Do you live in a*

HouseApartmentCondoMobile HomeOther
Do you own or rent?*

OwnRent
If rent, provide name and phone number of landlord:
Does your landlord allow dogs?*

YesNoN/A
Are there any restrictions from your landlord or subdivision?*

Number of petsSize or weight restrictionsBreed restrictionsNone
Do you have a fully fenced yard?*

YesNo
Height and type of fence
Do you have any of the following?*

Underground fence onlyTotally fenced in grassy area on your propertyDog park on your complex propertyNone of the above
How many people(adults and children) are in your household?*
How are you related to other adults in the household*

partner(spouse, domestic partner)I am the Son/DaughterRoommatelive aloneI am the Parent
How many children(under the age of 18) are in your household?*
If children, what are their ages?
Have your children been around animals before?*

YesNoN/A
Does anyone in your home have allergies to dogs or have asthma?*

YesNo
Current/Previous Pet Information
List any pets you own or have owned in the past five years, and their ages*
How many of these pets are spayed/neutered?*
Are your current pets up to date on their vaccines and heartworm/flea prevention*
Where are these animals now?
Have you ever owned a Shiba Inu in the past?*
Have you adopted from an animal welfare group before?*

YesNo
If yes, what group?
Have you ever given up a pet?*

YesNo
If yes, what were the circumstances?
Please provide the name and phone number of your current and/or previous veterinarian or clinic:*
New Pet Information
Are you interested in a particular Shiba? If so please type the name here.*
What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)*
What age range are you looking for?*

PuppyYoung adultAdultSeniorAny
Are you aware of crate training?*

YesNo
If the dog has an "accident" in your home, what type of correction do you plan to use?*
How many hours each day will your new pet be home alone?*
How many hours a day will you play with your pet during the weekdays*
How many hours a day will you play with your pet on the weekends*
Where will your new pet sleep at night?*
How will you supervise the dog's outdoor activity?*
Where will your new dog stay when nobody is home?*
What length of time will you allow your new pet to adjust to his new home?*
Are you willing to work through your new pet's issues, if any?*

YesNo
Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior?*

YesNo
Do you understand that a dog can be an 18 year commitment, and can cost $300 - $500 per year to care for?*

YesNo
Do you plan to take an obedience class with your dog?*

YesNoNot sure
If yes, where?
What circumstances would lead you to give up your new dog?*
What research have you done on the Shiba Inu breed before submitting this application *
Explain where you see yourself in 5 years. ie married, kids, moved into/out of current home, retired? *
How did you find out about SIRF?*

Adoptapet.comPetfinder.comFacebookFriend/Family MemberOther websitePetSmartOther
I understand that I assume full responsibility for the welfare of this pet from the date of adoption.
Signature

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SHIBA INU RESCUE OF FLORIDA

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information