First Name:
Last Name:
Street Address:
City:
State:
---Please Select---
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Northwest Territories
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ZIP:
Home Phone:
Cell Phone:
Work Phone:
Fax:
Work hours:
Email:
Occupation:
Spouse/Partner's First Name:
Spouse/Partner's Last Name:
Occupation of Spouse/Partner:
Referred by:
Veterinarian:
Vet's Phone:
Type of Dwelling:
House
Condo
Apartment
Do you have fencing?
Yes
No
If yes, fence type:
Chain Link
Wooden
Invisible
Fence Size:
Length: feet
Width: feet
Height: feet
Is your fenced area attached to the house?
Yes
No
Does the fence have a door leading into the house?
Yes
No
Are you willing to comply with Rescue's
fencing and leash policy ?
Yes
No
Other comments about your environment:
Why do you want an Old English Sheepdog?
If you have you ever owned a dog(s), please describe what kind(s).
What happened to your last pet?
How long did you have this pet?
If you have other animals, list type, age, sex.
Have you ever lost a dog?
Yes
No
Ever had one killed or injured?
Yes
No
Most Old English Sheepdogs are not good with young children. The herding instinct (purposely bred into them) is so strong that OES tend to be
rough and sometimes aggressive with young kids at play. Therefore, we need to know if you have or plan to have young children (under age 10) in
your home.
Do you have kids under age 10 living with you?
Yes
No
If none at present, do you plan to have young children
in your home?
Yes
No
Please list ages of kids under age 10.
List any allergies of home occupants.
Where will dog be kept during day?
Where will dog be kept at night?
How many hours will dog have to be alone?
Is someone home during the day?
Yes
No
Gender preference:
Male
Female
Either
Age preference (check all that apply):
Puppy
Young
Middle-aged
Senior
Would you take a deaf dog?
Yes
No
Would you take an OES mix?
Yes
No
Would you take an obedience class?
Yes
No
In order to adopt an OES from this program, it is necessary for you to have a personal interview and
grooming lesson with one of our volunteers. The purpose of the interview is to acquaint you with the breed,
its problems and in particular, grooming. When are you available?
Please put any further comments in the following box.