First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Cell Phone*

Please provide your age:*

What is your current occupation? How long has this been your occupation? *

A co-applicant is responsible person of at least 18 years of age that resides at the same physical address as the applicant. Both are expected to be fully committed to the lifetime responsibilities of an adopted dog. All below questions are for both the applicant and a co-applicant.

Co-Applicant Full Name:

Co-Applicant Age:

Co-Applicant Phone:

Co-Adopter Email Address:

What is the co-applicant's current occupation and how long at this employment?

Have you, a co-applicant or anyone who will be residing in the same home with the dog been charged with or convicted of animal abuse or neglect? If yes, please provide full details (Charge, Date, City/State): *

How long have you lived in your home?*

Do you have any plans to move within the next six months? If yes, please provide the address in the box below. If moving to a new rental home, please list the new landlord information as well. *

Do you rent or own (live with family) your home?*

If you rent, please provide your landlord's name and phone number. If your name is not on the lease, please provide the name of the leaseholder. *Please be advised - By submitting this application, you are giving approval to release your name to the Landlord during your Landlord check.*

If you rent, have you received the approval of your landlord to have a dog?

What type of home do you live in?*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Please list the names and ages of all members of the household:*

Are there any other people or pets that do not live with you who will be in frequent contact with the dog (i.e. significant other, children of the significant other, neighbors, children/pets in the extended family?). If yes, please describe:*

Does anyone in your home have known pet allergies? If yes, what animal(s) are they allergic to and how are those allergies managed?*

What does a typical day look like for current pets (if applicable). Who is the primary caretaker? How much exercise do the pets get? If no current pets, please describe your expectations of a typical day. *

Do you have German Shepherd, Belgian Malinois, or similar breed ownership experience? Please describe your skills and experience with the breed. *

Why are you interested in adopting a dog into your family at this time? What are your expectations and hopes for this new family member?*

In terms of age (a range is fine), size/weight, coloring, coat type or gender, what is your family looking for?

The following acknowledgement is required by the Applicant and Co-Applicant, if there is one. Application approval means that I/we will be approved to adopt from Shenandoah Shepherd Rescue. I/we understand that a dog I/we are interested in may not be available or may not be a good fit for the home. Upon approval, a caseworker will be assigned, and through the caseworker, introductions will be made with fosters/dogs that are good matches for the home. Please enter the applicant and co-applicant's names to indicate acceptance of this policy.*

Are you interested in a specific dog? (Note: Providing a dog's name does not guarantee adoption of that dog.)
Choose an animal: Baron 3197 Carmela 2925 Daisy 3178 Draco 1450 Freda 3157 Lucy 1641 Maggie (Justice) 0164 Peaches 0158 Samoa 1226 Victoria 3159

If applying for a specific dog and that dog is no longer available, will you be open to adoption of another dog?*

If you have applied to or been approved by another rescue within the last two years, please provide the name and location of that rescue.

What provisions would you make for ongoing care of your dog if you or a co-applicant are no longer able to support the physical or financial needs of the dog, or in the case of your death?*

Please describe any other reason(s) (issues that would cause a breaking point) that would compel you to return a dog to the rescue:*

Have you researched professional training and factored that in as part of the budget in conjunction with adopting a dog?*

How would you handle undesirable behaviors that may present in an adopted dog or with any resident pets? What is the plan if the approach is unsuccessful?*

Where would you expect the dog to spend its time while you are home? Where do you expect the dog to sleep?*

Will the dog be crated?*

How much time will the animal spend alone during the day*

Where will the dog will be kept when you are away from home for work, errands and other short term absences:*

Does your home have a yard?*

If yes, please describe the yard. Does it adjoin to another yard? Is it fenced (if so, what type of fencing and how high?)

Will the dog ever be outside alone for longer than a bathroom break?*

If Yes to the above question, describe the circumstances. Fenced (e-fence or physical fence), a dog run, a doghouse or tethered? Please fully describe the circumstances under which this would occur.

Provide contact information for three personal references who are not family members regardless of where they live, nor a spouse/significant other, or anyone living in your home or financially dependent on you.

Reference 1 Name:*

Reference 1's Relationship To You:*

Reference 1 Phone:*

Reference 1 Email Address:

Reference 2 Name:*

Reference 2's Relationship To You:*

Reference 2 Phone:*

Reference 2 Email Address:

Reference 3 Name:*

Reference 3's Relationship To You:*

Reference 3 Phone:*

Reference 3 Email Address:

Have you/co-applicant ever had a pet that injured another animal or person? If yes, please explain:*

Have you (or co-adopter) ever had to rehome or give up a pet? If yes, please describe the circumstances as completely as possible.*

Are there any pets in the home not owned by the applicant/co-applicant?*
Choose one: Yes No

If yes, for the protection of any resident animals as well as an SSR dog, we will need to ensure they are up to date on vaccines. Please provide the owner's name and veterinary provider contact information. Please ensure the provider is given permission to speak with us.

Below we will ask you about pets that you and your co-adopter (if applicable) have had full responsibility for in the last three years. This means decision-making responsibility, day-to-day care, and financial responsibility for medical care.

It is the applicant's responsibility to ensure the veterinary providers are given permission to speak with a representative of the rescue to verify vetting history. We recommend that you contact your vet provider(s) to confirm they are aware of this request and to validate that the records they have for your pet(s) are accurate. We will be asking for records under the applicant or co-applicant's name. Please ensure the name on the records are up to date to avoid delays or miscommunication. We will be asking about each of the items listed below.

If the vet cannot confirm that all pets are/were fully vetted per the list below or there is a medical reason that something was not provided, your application will be in jeopardy of denial.  

Canine (Required)
Spay/Neuter
Vaccines against rabies AND  parvo/distemper/hepatitis (DHPP)
Routine   heartworm testing in conjunction with year-round heartworm and flea/tick preventatives
Annual wellness visits

Feline (Required)
Spay/Neuter
Vaccines against rabies

We do strongly recommend annual wellness visits for all cats whether they are indoor only or indoor/outdoor. Many pets instinctively hide signs of illness. Without monitoring, by the time an illness manifests itself, it is often too late to help, and the pet has been suffering. Please also consider that if a cat spends anytime outside (intentionally or not), it is a best practice to provide vaccinations for feline leukemia, distemper/panleukopenia, rhinotracheitis, calicvirus. We would like to know that your feline family members are also protected from these terrible diseases.  

Given the above instructions, have you been responsible in this way for any pets? If no, please skip all vet questions and proceed to the end of the application. *

Veterinarian/Practice Name:

Please provide the Veterinarian's phone number:

Veterinarian's Address:

If different than the name on the application, provide the name the vet records are under:

If there have been other providers for routine veterinary care, please provide the contact information here. You may also include other providers if you wish (specialists, ER, etc)

Please list the names of any pets that you/co-applicant have had care-taking responsibility for in the last three (3) years.

Please list the names of any deceased/rehomed pets that you/co-applicant have had care-taking responsibility for in the last three (3) years.

Heartworm Preventatives: Please supply the brand, where you purchase them from and how often you administer for each pet.

Flea/Tick Preventatives: Please supply the brand, where you purchase them from and how often you administer for each pet.

Pet Name, Species, Age:

How long have you been responsible for this pet?

Has this pet had a verifiable history of: (select all that apply)

Pet Name, Species, Age:

How long have you been responsible for this pet?

Has this pet had a verifiable history of: (select all that apply)

Pet Name, Species, Age:

How long have you been responsible for this pet?

Has this pet had a verifiable history of: (select all that apply) :

Pet Name, Species, Age:

How long have you been responsible for this pet?

Has this pet had a verifiable history of: (select all that apply):

Pet Name, Species, Age

How long have you been responsible for this pet?

Has this pet had a verifiable history of (select all that apply):

If you have more pets to list, please provide the above information for each pet.

If any of the pets you have been responsible for are missing any of the care as described, please provide as much information as possible regarding the reason for this:

How did you hear about us?*
Choose one: Internet Search Facebook Instagram Word Of Mouth Television Adoption Event Newspaper Other Website Other

You must agree to the following terms and conditions for this application to be considered.  Submitting this form indicates agreement.

I certify that the information entered on this application is accurate and true to the best of my knowledge.

I understand that providing false information is grounds for denial of my application.

I certify that I am providing consent to SSR to contact my Veterinarian and my References for further information if needed.

I certify that I am not applying for someone else, i.e., I am applying in my own name.

I understand that as a requirement to adopt I must keep my dog on heartworm prevention and flea and tick prevention at all times.

I understand the cost, time and physical demands that come with pet ownership.     

I am willing to allow a Shenandoah Shepherd Rescue  representative to come to my home and conduct a home visit.

I understand that if I have listed a co-applicant, he/she must be fully informed and in agreement with the application/adoption.

I understand that SSR does not support adoptions as “surprises” or “gifts.”

I understand that SSR does not support adoptions as working, support or service dogs. SSR dogs are companion dogs only.

I understand that during the home visit all members of my household must be present.

I am 18 years or older and am legally allowed to adopt a pet.     

I understand that submission of this form provides a signature.

Do you agree to the terms and conditions listed above?*

Additional Comments/Information:

Please Remember To:

Notify your vet that an SSR representative will be calling.

Check your spam/junk mail folder if you do not hear from us within a week.