Mid-South Shepherd Rescue

Due to the time involved in processing applications please advise us if you have adopted elsewhere, are no longer interested in adopting, or would like to withdraw your application as soon as possible . This will allow us to spend our time working on open applications to find homes for our dogs.

Please do not consider adopting any of our dogs simply because they have a sad story behind them unless you are completely and totally committed to seeing them through their problems and adjustment. Moving from place to place will only add stress to their lives and can cause more problems. Dogs have feelings to, please think of theirs when making the decision to bring one into your home. Our goal is to have this be the last move in their lives, their FOREVER home.

Adoption Application

Name(s) of dog(s) you wish to adopt, Please remember that we cannot guarantee or hold dogs. The dog you name may be adopted by the time your application is approved, or may already be scheduled to meet his/her new family. Applications are processed in the order they are received. We can continue with the application process (pre-approve you) so you would be ready for the next dog when it comes in
Applicant’s name
If you are 21 or younger, how old are you?
Telephone - work
Telephone - home
Telephone - cell
E-mail
Home address
City
County
State
Zip
Do you live in a
Do you own or rent?
If you do NOT rent your home, are you the owner of the home? Who owns the house?
Landlord name
Landlord phone
Applicant’s employer
Are there any ordinances in your area that limit the amount of pets or breed of dogs that you can own? If so, please explain:
Does anyone in your home have allergies to animals?
Does anyone have asthma?
Are you aware that German Shepherds are active, very intelligent dogs who shed and require a lot of exercise and interaction with their family?
*Is your yard totally* fenced in?**
Type of fence
Height of fence
Where will the pet be kept during the day? RESPONSE IS REQUIRED.
Where will the pet be kept during the night? RESPONSE IS REQUIRED.
Where will the pet be kept during routine absences such as trips to the grocery store? RESPONSE IS REQUIRED.
Do you have a pet door? If so, how is it used, how often is it used, and under what circumstances?
Do you have a kennel run? If so, how is it used, how often is it used, and under what circumstances?
Do you have a dog house? If so, how is it used, how often is it used, and under what circumstances?
Do you have a tie-out stake? If so, how is it used, how often is it used, and under what circumstances?
Do you have a crate? If so, how is it used, how often is it used, and under what circumstances?
How many adults live in your home?
How many children live in your home?
What are the ages of the children?
If you do not have children yourself, are there children who visit your home regularly (defined as once a month)?
I have read the description of the dog carefully and believe that my household is in compliance with the limitations placed on the dog’s placement. (For example, if the description says “no cats,” the household should not have cats.
Have you owned a German Shepherd before? If so, please give us a brief history
How long have you been thinking about adopting a dog?
Why have you decided to get a dog and why, specifically, a shepherd?
What is your preference in terms of the gender of your dog?
What is your preference in terms of the age of your dog?
What is your color preference?
What size dog are you looking for?
If the listed dog is adopted, or in the process of being adopted, do you wish to continue the application process to be pre-approved for another dog, or one that may be joining later? We recommend continuing with the application process towards pre-approved status so you'll be ready for the next dog you are interested in
How many hours at one stretch will the pet be without humans each day?	in hours
How many hours TOTAL will the pet be without humans each day?	in hours
Who will be the primary caregiver?
What is the primary caregiver’s relationship to you?
Who will care for the animal while you are on vacation?
What will you do with the animal if you move?
Are you willing and able to provide pet care for the next ten or more years, including vet checks, vaccinations, boarding, medical care, indoor housing, etc.?
What do you think pet care costs per year, including animal vaccinations, food, toys, minimal boarding, grooming, etc.?	$
Are you willing and able to support a pet?
Do you understand that dogs need to be kept on heartworm prevention year round, to insure they do not catch this deadly disease?
We require all animals adopted from us to be spayed or neutered. Do you have any questions or reservations about this policy?
Please list all pets you have owned in the past ten years. If none, then include pets owned in childhood. PLEASE LIST ANY ANIMALS RESIDING WITH YOU, EVEN IF YOU DO NOT OWN THEM.
Pet 1 Pet’s name Breed Gender Age Spayed/neutered How long owned in years What happened to the pet? If deceased, how old was the pet when the pet died and explain details of the death If deceased, in what year did the pet die?
Pet 2 Pet’s name Breed Gender Age Spayed/neutered How long owned in years What happened to the pet? If deceased, how old was the pet when the pet died and explain details of the death If deceased, in what year did the pet die?
Pet 3 Pet’s name Breed Gender Age Spayed/neutered How long owned in years What happened to the pet? If deceased, how old was the pet when the pet died and explain details of the death If deceased, in what year did the pet die?
Pet 4 Pet’s name Breed Gender Age Spayed/neutered How long owned in years What happened to the pet? If deceased, how old was the pet when the pet died and explain details of the death If deceased, in what year did the pet die?
If you have additional pets, please list their names and ages here.
Are your current pets (if applicable) on monthly heartworm prevention?
Are your current pets (if applicable) up to date on routine vaccinations?
If you have ever had a pet lost, disappear, or die at an early age, please provide details (dogs dying before age 10).
Have you ever sold, given away, or surrendered a pet?
How do you plan to exercise your dog? (provide details)
Who will supervise outdoor activities?
How will the dog be confined outside during exercise?
Have you ever trained a dog?
Are you willing to give this dog time to adjust to its new environment and family members?
How much time are you willing to give the dog to adjust to its new environment and family members?
The animal may not be housebroken. Are you willing to take the time to work with the animal?
Name of past/current vet. NOTE: Please contact your vet after filling out this application and give him/her permission to talk to us about the care provided to your pets by them.
Phone number of past/current vet.
Names of pets treated
Name of intended vet
Are there any existing circumstances (e.g., health, family, professional, financial) that could result in your being unable to take care of this dog? What are they?
How did you hear about us? Or who referred you?
We require a home visit as part of the application process. Will you comply?
We require that all family members, including animals, meet the animal prior to placement. Will you comply?
We require a minimum donation of $250 at the time of placement. This money goes to fund medical care, food and shelter for all of our animals, not merely the one you are applying for. Will you comply?
Have you applied to adopt from any other organization within the last 90 days?
If yes, what is the status of that application?
Is there anything else we should know that would help us to understand your application?
A rescue representative will conduct a formal interview with you and your family prior to adoption. This interview is to answer any questions about your new pet and to alert you to problems that may arise. The rep will help you plan how to successfully introduce your new pet to your new home and to explain how to help your new pet become part of the family. Please make sure that you have answered all questions in this application. Failure to provide information necessary to complete this application may cause this application to be voided. As part of our adoption process, you will be asked to sign a contract/adoption agreement. You must be willing to sign and abide by this agreement. If at any time any part of this agreement is violated, you must be willing to surrender the dog back to us immediately. I certify that I have carefully read and agree to all the provisions in this application. I have answered all questions as completely and honestly as possible. I understand that if it is discovered that I have falsified any information on this application, my application will be denied. Furthermore, if a dog from MSSR has already been placed in my care, I will be required to immediately surrender the dog back to MSSR, and will forfeit the adoption fee. By typing my name below and submitting this application, I am agreeing to all the aforementioned statements
Applicant’s signature
Date