Shiba Inu Rescue Association (SIRA)

forth by Shiba Inu Rescue Association.

I certify that I, have read and agree to the above conditions as set

First Name:

Last Name:

Age:

Occupation:

Email:

Occupation:

Age:

Last Name:

Spouse/Partner's First Name:

Address:

City:

State:

Other Phone:

Home Phone:

Nearest Large City:

Zip Code:

List all other adult members in the household. Include names, ages, occupations and relationships to you:

If yes, who is it for?

Is the dog a gift?

Who will be the primary cartaker of the rescue dog?

If yes, please provide names and ages:

Are there children in your household?

Have you owned a Shiba Inu before?

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

What do you like the least?

Is the Shiba still residing with you?

If not, please explain:

If you have NOT owned a Shiba Inu before, but have had another breed of dog, tell us what
breed(s) and what you like most about owning it?

What do you like the least?

If you have NOT owned a Shiba Inu before, please explain how you learned about the breed:

Why are you interested in adopting a rescued Shiba Inu?

Please list all the pets you have owned, beginning with the current or most recent pets.

Include Name/Gender/Type of Pet/Breed/Age/Currently own-Deceased-Given away/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?

If yes, please explain:

Have you ever had a pet euthanized?

If yes, please explain:

Have you ever had a pet lost or injured in an accident?

If yes, please explain:

Have you ever applied to another rescue group or shelter?

If yes, which one(s)?

Were you approved?

If not please explain:

What is your current living arrangement?

If other, please explain:

If renting please provide your landlord's name:

Phone Number:

Weight/breed/number of pets restrictions:

Have you moved in the past 10 years?

Are you planning to move in the next 10 years?

Would you ever consider moving to a place that does not allow pets?

Do you have a yard?

If yes, is it securely fenced?

Height of fence:

Type of fence:

How and when will the rescue 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 rescue dog?

If yes, in what capacity?

Does anyone in your household have pet-related allergies?

If yes, please explain:

What is the activity level of your household?

Where will the rescue dog stay during the day?

If other, please describe:

Where will the rescue dog stay during the night?

If other, please describe:

What will happen with the rescue dog when you have to travel for business, vacation, etc?

If other, please describe:

Are you aware that all rescue dogs experience a period of adjustment after entering their new home, during which time the dogs may exhibit undesirable behaviors, including but not limited to: potty accidents, marking, chewing and digging?

If the 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?

If yes, please explain:

Do you have experience training a dog?

Please provide your training facility's name:

Phone number:

Do you need recommendations for trainers in your area?

Select all ages you would consider:

**Please keep in mind there are very few puppies in rescue**

Preferred gender:

Select all colors you would consider:

What activity level(s) would you would prefer?

Please explain your preferences:

Would you consider Shiba mix or Jindo mix?

Would you consider an older dog?

Would you consider a special needs dog?

Would you consider something other than your selected preferences?

Are there any dogs currently available that you are interested in?

If yes, which one(s):

Would you adopt a dog sight unseen?

How far are you willing to travel to meet a dog?

Please provide your veterinarian's name:

Phone number:

Do you need recommendations for veterinarians in your area?

Please provide two non-related references, that do not reside in your home for us to contact. These should be people that have been around your pets or are familiar with your pet experience. If this is not possible (ie you have never owned pets or have not owned any for many years) than you may provide references who are unfamiliar with your pet experience, but know you well.

Any other information or comments:

I will notify Shiba Inu Rescue Association if I cannot keep the rescue dog for any reason. The dog may never be given to an individual, shelter or another rescue organization.

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

I will maintain the necessary vaccinations recommended by my vet and be responsible for attaining the required licenses in accordance with the regulations in my community/city/county/state/etc.

I am willing/able to be responsible for all routine and unexpected emergency care for a rescue dog.

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

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

I will keep the rescue dog as a pet in my home as a part of the family. I will not keep it outdoors or leave it outside unattended for any extended length of time.

I will never allow the rescue dog to run off leash in a non-securely fenced area.

I understand that Shiba Inu Rescue Association reserves the right to deny my application at anytime, for any reason should it be determined that my home is not suitable for a rescued Shiba Inu.

I understand that Shiba Inu Rescue Association reserves the right to reposes the rescue dog should any portion of the adoption contract be breeched or if it is determined that the rescue dog is abused or neglected in any way.

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

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

Cream

Black & Tan

Sesame

Red

High - Running Buddy

Medium - Walking Buddy

Low - Couch Potato

forth by Shiba Inu Rescue Association.

General Information

Pet Experience

Household

Training

Preferences

References

Read and Sign

Check to Agree

Requirements for Adoption

*Constitutes electronic signature

All references, personal, veterinarian and landlord, will be checked prior to a home visit being arranged. If you do not want want them to be contacted DO NOT SUBMIT THIS FORM. Also be sure to contact your vet immediately and give them permission to release your records to Shiba Inu Rescue Association. Failure to do so will result in a delay of the application process.

Once your references have been verified you will be contacted to arrange a home visit. This may take a few days depending on how quickly our volunteers are able to get in contact with your references. If at any point during the process you decide you do not wish to adopt please send an email to adoption@savingshibas.com.

Head of household must fill out this form.
You must be at least 18 years old to apply to adopt a dog.

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

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

Adoption Application