Dog you are interested in? *

First name *

Last Name *

Age *

Full Address Include City, State and Zip *

Best Phone Number to Reach You *

Work Phone

How long have you lived at current address? *

Do you have plans to move, if so when and where? *

If you rent your home or share a home, does your landlord allow large dogs? (Please be able to provide this in writing) *

What type of property is your home? *

Is your yard fenced? *

If you have a fenced yard, what material is your fencing? (We prefer to not place shiba's in homes with wireless fences aka air fences). Type NA if this is not applicable to you. PLEASE INDICATE THE HEIGHT OF YOUR FENCING *

Check all that apply *

Do you have other adults living with you? *

If you have other adults living with you please list their names here - one per line please, Type NA if this is not applicable to you. *

Who will be primary caretaker of dog?

Do you have children that live with you or visit regularly? *

If you have children that live with you or visit regularly, please list their names and ages here. One per line. Type NA if this is not applicable to you. *

If you have children that live with you or visit regularly, have the children been taught how to interact with dogs and/or already had exposure to dogs? If this is not applicable select NA. *

If you have children that live with you or visit regularly, how do they react to dogs? If not applicable, type NA. *

Is anyone in your home or who visits regularly allergic to dogs? *

Is anyone in your home or who visits regularly afraid of dogs? *

Would you consent to a home check? *

Occupation & Employer *

Employer Address *

Employer Phone *

How long have you worked for this company? *

Would you be willing to provide references to verify employment, if requested? *

Have you owned a dog before? *

If you've owned a dog before, how many & what breed(s)? Please one per line - if not applicable please type NA. *

Why do you want a dog? *

Do you have other pets in your home? (dogs, cats, birds, etx) *

If you have other pets in your home - please list what species & breed, if they're spayed/neutered, their gender and their temperament. If not applicable type NA. *

Any potential problems with your current pets?

What would you expect your daily routine to be with your new dog? *

What age range are you looking for? *

Do you have a gender preference *

If you have a gender preference, please explain why? If you do not please type NA. *

Please describe the traits that made you interested in a Shiba Inu and/or Jindo? What do you like and/or dislike about those traits? *

Which of the following would you use to train a dog to heel or walk on a loose lead? (choose all that apply) *

Any comments on the effectiveness of any of the above listed methods?

Will you take your dog to obedience training? *

Describe two pet-behavior problems you have worked through and how you solved the problem. (Problems such as soiling in the house, growling, pulling on the lease, won't come when called, dog not eating its food, etx.) *

How much time will you spend with your dog on weekdays? *

How much time will you spend with your dog on weekends?

How many hours a day will your dog be left alone? *

Where will your dog be when you work? *

Where will your dog sleep? *

Will your dog be crated or restrained, or will they have free run throughout day? *

Will your dog be tied out? *

How often will your dog be walked? By whom? *

How often will your dog be played with? By whom? *

Who will care for your dog when you are away overnight or on vacation? *

Are there any unusual circumstances your new dog will need to adapt to? *

Any additional comments regarding your daily routine?

How much have you budgeted to care for your dog on an annual basis? *

Do you feel financially able to care for an dog for its lifetime? *

Do you feel physically able to care for an dog for its lifetime? *

What Veterinary Clinic do you use or plan to use? (clinic name, address and phone number please) *

Do you see a specific vet at this practice? If so, whom? If not applicable, type NA. *

Please feel free to add any other information you think would be useful for us to know.

The information I have provided in this document is correct and true to the best of my knowledge and I have not withheld any pertinent information. I understand that any misrepresentation of me or my family or any untruths of the information I have provided herein that are discovered at a later date will invalidate any adoption agreement and will give Shiba Rescue of New Jersey the right to reclaim the dog without my permission and without refund of any adoption donation. Entering your initials in the box below and submission of this form provides agreement to this adoption application. *