The purpose of this application and questionnaire
is to help us evaluate your desires and give us some insight into your daily life so that
we may ensure the best possible match when you adopt a dog.
Please feel free to add details to answers and use extra paper if needed.
When we sponsor rescues it is very important that proper placements are made.
We reserve the right to refuse placement of an animal in our custody for any
reason, without explanation.
Applicant(s)
Name:
Address, City,
State, Zip:
Phone:
( )
Email:
May we contact
you at home during the day? □ Evening?
□
Age:
18-25 □ 26-39 □
40-49 □ 50-59 □
60-70 □ Over 70 □
Work Status:
Currently employed □ Current employer:
Unemployed □
Retired □
How long have you been employed at this location?
Position:
If you are self-employed, what is the name and nature of the
business?
Previous
Employer:
For how long?
How many hours
per week do you work?
Attend School:
Yes □ No □
Part-time □
Full-time □
Name of school:
Seeking what license/certification/degree?
Relationship
Status: Married
□
Divorced □ Separated
□ Single
□ Other
□ (i.e.: engaged,
committed relationship)
If other, please elaborate:
Spouse/Partner
Name:
Address:
Phone:
( )
Email:
May we contact
you at home during the day? □ Evening?
□
Age:
18-25 □ 26-39 □
40-49 □ 50-59 □
60-70 □ Over 70 □
Work Status:
Currently employed □ Current employer:
Unemployed □
Retired □
How long have you been employed at this location?
Position:
If you are self-employed, what is the name and nature of the
business?
Previous
Employer:
For how long?
How many hours
per week do you work?
Attend School: Yes
□ No □
Part-time □
Full-time □
Name of school:
Seeking what license/certification/degree?
Relationship
Status: Married
□
Divorced □ Separated
□ Single
□ Other
□ (i.e.: engaged,
committed relationship)
If other, please elaborate:
Annual
family income
20-35,000 □
36-50,000 □
51-65,000 □
66-100,000
□
101-150,000 □ Over
150,000
□
Your home/life/expectations
Please describe your family
situation, (number of adults and children, ages of children, any special family situation
such as a handicapped individual or frail elderly individual within your home:
Do you have other
pets? Yes □ No □
If so please list pets, age, sex
and species. Are they spayed/neutered?
In the past what
has happened to other pets you have had: are
they still alive, died of old age, disease, given away or sold, turned in at a local
shelter?
Please describe
your housing situation: Rent □ Own
□ Pool □
If yes, is pool area screened? Yes □ No □
Yard size: Large: □ Medium □
Small □
The yard is: Fenced □ Unfenced □
If fenced, is the entire yard fenced
or a specific area? If the latter, please describe:
Type & height
of fencing:
Please tell us what attracted you to a Keeshond and in particular,
why you would like to adopt a rescued Keeshond:
Please describe the potential dog’s living arrangements:
Outside only □
Inside and outside □ Where
will the dog sleep at night?
Do you have a crate for the dog? Yes □ No □
Have you ever used a crate for any of your dogs in the past? Yes □ No
□ If yes, please
elaborate:
Have you ever
done obedience training with a dog? Yes □
No□
Please describe method (i.e. professional trainer, structured group, individual
classes, clicker training, self-taught, other:
Are you interested in specific activities in which you and your dog
may participate (i.e. flyball, agility, other)? Yes □ No □ If
yes, elaborate:
Have you ever bred Keeshonden or other dogs?
Yes □
No □ If
yes, please elaborate:
Have you had any personal experience with this breed? Yes □ No □
If yes, please elaborate:
Is there a specific dog you are interested in adopting?
Yes □
No □ If yes, what is
the dog’s name or ID:
Are you open to discussing the adoption of the dog determined to be
the most suitable match for your family even if it is not the specific dog for whom you
are applying? Yes □
No □
Do you have a preference as to whether you adopt a male or female? If
yes, please explain:
Tell us a little
about your life and how you see a dog fitting in (i.e. active family, hiking, running,
camping etc. or quiet, retired, prefer older
settled dog:
What hobbies do you enjoy?
Estimate the number of after-work hours you are away from home each
week (i.e. classes/shopping/hobbies/children’s activities, etc.):
When you are away (vacations, business travel, etc.) what will
happen to your dog? Travel with you on trips□ Stay at boarding kennel □ Dog sitter will come to
your house □
Stay with Relative/Neighbor □ Other □ If other, please explain:
References
At the time you submit this application, please be sure to notify
those listed as veterinarian and personal references that we will be contacting them and
assure them that they have your permission to talk with us. This will help them to feel
more comfortable when talking with us and help us in processing your application.
Thank you.
Veterinarian
reference: Name:
Name of
Animal
Hospital
or Veterinarian Clinic:
Address:
City, State, Zip:
Telephone
number: ( )
M – F Business Hours:
Provide two personal (non-family)
references that can attest to your interest, interaction and feelings about animals in
general and dogs in particular.
1) Name:
Relationship (i.e.: friend, coworker, neighbor):
Address:
City, State, Zip:
Telephone
number: ( )
E-mail:
Best day and time to reach this person:
2) Name:
Relationship (i.e.: friend, coworker, neighbor):
Address:
City, State, Zip:
Telephone
number: ( )
E-mail:
Best day and time to reach this person:
Agreement
and Signature(s)
At the
time of the adoption, I understand that I will be required to sign an adoption contract
and abide by the articles set forth in that contract. Additionally, I will be responsible
for a nonrefundable payment in full of any medical expenses incurred during foster care in
connection with the specific keeshond I adopt. Receipts will be provided at the time
payment is made and an additional donation to help fund and provide care for Keeshonden in
foster care is encouraged:
(Initial)
________
I
understand and agree that if I am, at any time in the future, unable to care for my
adopted dog, that dog must be returned at my expense to the person or persons from whom it
was obtained. In
the event the dog I adopt must be returned to Florida Keeshond Rescue because I am no
longer able to care for him/her due to my ill health/death or other extenuating
circumstance, I will, to the best of my ability, provide financially for the continued
care and housing of my adopted dog, either by donation or provisions in my will. The dog may not be
abandoned, given or sold to anyone else, or turned over to any shelter, pound, humane
society or similar organization. I understand and agree that this dog may not at any time
for any reason be used in or for any medical or other experimental endeavors. Please
initial to indicate your acknowledgement and agreement with this clause. Initial here:
______
By signing
below, I certify the information provided by me is true and complete to the best of my
knowledge and I recognize that any misrepresentation of that information will result in my
losing the privilege of adopting a rescue Keeshond. I understand that Florida Keeshond
Rescue has the right to deny my request to adopt a Keeshond, and I authorize checking of
all information provided in this application.
Signature(s):
Date:
Revised 10/20