Have you owned a Shiba Inu before? Yes No *

If yes, what do you like most about owning a Shiba?

What do you like the least?

Is the Shiba still residing with you? Yes No

If not, please explain.

If you have owned another breed of dog, tell us what breed(s) and what you like most about owning it?

What do you like the least?

Please explain how you learned about the Shiba Inu breed. *

Why are you interested in adopting a rescued Shiba Inu? *

Please list all the pets you currently own. Name/Gender/Type of Pet/Breed/Age/Health/Length of ownership *

Please list all the pets you have owned in the past that no longer reside with you. Name/Gender/Type of Pet/Breed/Age/Reason pet no longer resides with you/Length of ownership *

How do your current pets get along with new dogs? Please be specific.

Have you ever given away an animal or surrendered one to a shelter/rescue group? Yes No *

If yes, please explain.

Have you ever had a pet euthanized? Yes No *

If yes, please explain.

Have you ever had a pet lost or injured in an accident? Yes No *

If yes, please explain.

Have you ever applied to adopt a pet from another rescue group or shelter? Yes No *

If yes, which one(s)?

Were you approved? Yes No

If not please explain.

What is your current living arrangement? Select Own Home Own Townhouse Own Condo Rent Home Rent Apartment Living with Family or Relatives Other *

If other, please explain.

If renting please provide your landlord's name.

Phone Number

Please list all weight/breed/number of pet restrictions.

Have you moved in the past 10 years? Yes No *

If yes, please list. Previous City and State/Living arrangements/How long at residence/Month and year moved away/Was residence pet friendly

Are you planning to move in the next 10 years? Yes No *

If yes, please list. Future City and State/Living arrangements/Month and year moving/Will residence be pet friendly

Would you ever consider moving to a place that does not allow pets? Yes No *

Do you have a yard? Yes No *

If yes, is it securely fenced? Yes No

Height of fence. Select Underground Under 4 ft 4 ft 5 ft 6 ft Over 6 ft

Type of fence Select Wood Chain Link Brick Invisible/Electric Other

How and when will the adopted dog be exercized? *

List how long each adult in the household is typically away from home during weekdays. *

During weekends *

If applicable, will the children in your household be expected to care for the adopted dog? Yes No

If yes, in what capacity?

Does anyone in your household have pet-related allergies? Yes No *

If yes, please explain.

What is the activity level of your household? Select Low Medium High *

Where will the adopted dog stay during the day? Select Crated Gated in Room Free Run of Home Outside Other *

If other, please describe.

Where will the adopted dog stay during the night? Select Crated Gated in Room Free Run of Home Outside Other *

If other, please describe.

What will happen with the rescue dog when you have to travel for business, vacation, etc? Select all that may apply. Boarded
Pet Sitting Service
Stay with Friends or Family
Take Dog With
Other
*

If other, please describe.

Are you aware that all rescue dogs experience a period of adjustment after entering their foster home, during which time the dogs may exhibit undesirable behaviors, including but not limited to potty accidents, marking, chewing and digging? Yes No *

Are you prepared and willing to work through the adjustment period? Yes No *

If the foster dog makes a mistake (potty accident, chewing, aggression, etc.) please explain how you would correct the behavior: *

Do you plan on attending positive based obedience, canine good citizen, agility or any other training classes with the rescue dog? Yes No *

Do you have experience training a dog? Yes No *

If yes, please explain.

Please provide your training facility's name.

Phone number

Do you need recommendations for trainers in your area? Yes No

Select all ages you would consider adopting. **Please keep in mind there are very few puppies in rescue** Young puppy - Under 6 months
Puppy - 6-12 months
Adolescent - 1-3 years
Young adult - 4-6 years
Adult - 7-9 years
Senior - 10+ years
*

Preferred gender Male Female Either *

Select all colors you would consider. Red
Sesame
Black & Tan
Cream
Other
*

Select all activity levels would you would consider adopting. Low - Couch Potato
Medium - Walking Buddy
High - Running Buddy
*

Please explain your preferences. *

Would you consider adopting something other than your selected preferences? Yes No *

Would you consider adopting a special needs dog? Yes No *

Would you consider adopting an older dog? Yes No *

Would you consider adopting a Shiba mix or Jindo? Yes No *

Are there any dogs currently available that you are interested in? Yes No *

If yes, which one(s)?

Would you adopt a dog sight unseen? Yes No *

How far are you willing to travel to meet a dog? Select Under 25 miles 25 miles 50 miles 100 miles 200 miles 200+ miles *

I will never allow the adopted dog to run off leash in a non-securely fenced-in area, and I will directly monitor the adopted dog whenever outside, even if the dog is in a securely fenced-in area or on a tie-out. Agree Disagree *

I will keep the adopted dog as a pet in my home as a part of the family. I will never keep it outdoors or leave it outside unattended for any extended length of time. Agree Disagree *

My rescue dog will wear an identification tag at all times. Agree Disagree *

I understand that adoption fees range from $200-$400 depending on the dog's age. Agree Disagree *

I am willing/able to be responsible for all routine and unexpected emergency care for the adopted dog. Agree Disagree *

I will maintain the necessary vaccinations for the adopted dog that are recommended by my vet and be responsible for attaining the required licenses in accordance with the regulations in my community/city/county/state/etc.censes in accordance with the regulations in my community/city/county/state/etc. Agree Disagree *

I will contact Shiba Inu Rescue Association and provide notification of any changes in contact information from what is listed on this application. Agree Disagree *

I will notify Shiba Inu Rescue Association if I cannot keep the adopted dog for any reason. The dog may never be given to an individual, shelter or another rescue organization without the permission of SIRA's Board of Directors. Agree Disagree *

I will not have the adopted dog euthanized or undergo any sort of elective surgery without the recommendation of a vet and written permission from Shiba Inu Rescue Association. Agree Disagree *

I understand that Shiba Inu Rescue Association reserves the right to repossess the adopted dog should any portion of the adoption contract be breeched, and I agree to cooperate fully with such repossession in the event that occurs. Agree Disagree *

I understand that Shiba Inu Rescue Association reserves the right to deny my application at any time and for any reason. *

I certify that I have read and agree to follow the above conditions as set forth by Shiba Inu Rescue Association. *Constitutes electronic signature. *

I certify that I have read and agree to follow the above conditions as set forth by Shiba Inu Rescue Association. *Constitutes electronic signature.

How did you learn about SIRA? Internet Search SIRA Adopter/Volunteer Recommendation Family/Friend Recommendation Petfinder/Other Adoption Website Event Facebook Twitter Craigslist Other *

Any other information or comments.