MOESR-Adoption-Application

Midwest OES Rescue Adoption Survey

Carefully complete this application answering each question as truthfully as possible. If a question does not apply, please indicate NA or none in the box. Questions with an * require a response.

First and Last Name *

Street Address *

City *

State *

Zip Code *

Home Phone *

Alternate Phone

Fax Number

Email *

Confirm Your Email *

Occupation *

Work Hours *

Spouse's/Partner's Name *

Spouse's/Partner's Occupation *

Referred to MOESR by

Veterinarian's Name and Clinic/Hospital Name *

Veterinarian's Phone Number *

Type of dwelling. *

House Condo Apartment

Do you have fencing? *

Yes No

If yes, indicate the TYPE of fence.

No Fence Type Selected Chain Link Fence Wooden Fence Invisible Fence

Describe fence size including length, width and height.

Is your fenced area attached to the house?

Not Applicable Yes No

Does your fenced area have a door leading into the house?

Not Applicable Yes No

If not in a secured area, are you willing to always keep this dog on a leash and in your control? *

Yes No

Comments

Why do you want an Old English Sheepdog? *

Describe all previous dogs owned including breed type. *

List all animals you now own, care for or intend to own. Include type of animal, age and sex. *

What happened to your last pet and how long did you have this pet? *

Have you ever had a dog injured or killed? *

Yes No

If you've ever had a dog injured or killed before, please explain what happened.

Most OESs are NOT good with young children. The herding instinct which is purposely bred into these dogs is so strong that OESs (in general) tend to be rough and sometimes aggressive with young kids at play. Because of this, we need to know if you have or plan to have young children (under the age of 10 years) in your home.

List ages of ALL children under the age of 18 years that live with you either full or part time including visiting children *

If no children are present, do you plan to have young children in your home?*

Yes No

Are there any elderly or frail people who live in your home? *

Yes No

Where will the dog be kept at night? *

How many hours will your dog have to spend alone each day? *

Where will your dog be kept during the day? *

Is someone home during the day? *

Yes No

List allergies of home occupents. *

Groomer's Name & Phone Number

Are you interested in a particular dog? (Indicate name.)

Gender preference of the dog you wish to adopt. *

Male Female Either

Is there an age preference for the dog you wish to adopt? Check all that apply. *

8 weeks to 6 months 6 months to 1 year 1 year to 3 years 3 years to 7 years 7 years or older Will consider any age.

Check any of the following special dogs you would consider adopting.

Deaf Blind Special Needs

Are you willing to take obedience classes with this dog and a trainer in your area if you adopt from us? *

Yes No

What behavioral issues do you consider unacceptable? *

Do you have an appropriate size indoor crate/kennel for the dog? If not are you willing to purchase one if needed? *

Please feel free to include any additional information or comments below.

The answers you've provided on this application will help us to match an Old English Sheepdog to your lifestyle and requirements. Carefully review your answers above, then submit your completed adoption application to MOESR by clicking the button below.