Kansas City Sheltie Rescue
P. O. Box 57
Mission, Kansas 66201
Phone/Fax: (913) 384-0366
Please use the "Tab" key to move through the fields.
1. What Sheltie/s are you interested in?
2. Your Name
3. Spouse Name?
4. Your DOB?
5. Spouse DOB?
6. Email Address?
7. Home Phone Number?
8. Cell Phone Number
13. Your Occupation?
14. Spouse Occupation?
15. Your Work Phone?
16. Spouse Work Phone?
17. Have you ever owned a Sheltie?
18. List previous & present pets and what happened to them
19. Were/Are they Spayed/Neutered?
20. Were/Are they Current on Vaccinations?
21. What Flea Prevention do you use?
22. What heartworm Prevention do you use?
25. For what purpose do you want this dog?
26. Do you have children?
27. How many?
28. Children's ages?
29. Do you live in a House, Apartment, Condo, Trailer, Other?
30. Do you own or rent? If you rent, please include your landlord's name and phone #
31. Do you have a fenced yard? What kind of fence/s?
32. Do all adults in the family work?
33. Is someone home during the day?
34. Number of hours a day no one is home?
35. Is anyone in your home allergic to dogs?
36. What provisions will be made for your Shelties if no one is home during the day?
37. Where will the dog sleep at night?
38. While you are gone?
39. Are other members of your household aware you are considering adopting a dog?
40. Any Objections?
41. Are you prepared to accept the financial responsibilities of caring for an animal?
42. Are you prepared to provide good care including good quality food, licensing, veterinary care, etc.?
43. What would you do with the dog if you move?
44. Are you familiar with the animal control regulations in your area?
45. What circumstances, in your mind, justify getting rid of a dog?
46. List the Clinics or Vets and phone numbers of ALL veterinarians used in the last 8 years.
47. May we call youe vets?
48. Are you willing to allow a rescue representative to visit your home by appointment?
49. Other additional information or details you would like to provide?
23. Where do your current pets spend the day?
50. You understand that falsification of any of the above information can result in denial of an adoption?
24. Where are your current pets when no one is home?
Official Use Only
Vet Reference Checked By?
Vet Check Date
Home Visit/Fence Check By?
Home Visit/Fence Check Date