Owner Information

Name:

Address:

City:

State:

Zip:

Phone Number Home:

Phone Number Work:

Phone Number Cell:

Email:

Referred By:

Occupation:

Hours:

Spouse/Partner Occupation:

Hours:

Veterinarian

Veterinarian Name/Clinic Name:

Veterinarian Address:

Veterinarian Phone Number:

Dwelling Information

Dwelling Type?

Is your yard fenced?

Fence Type?

Fence Height:

Is the fenced area attached to the house?

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

Other Enviroment Comments:

If you have ever owned a dog(s) in the past, please describe what kind:

What happened to your last pet?

How long did you have this pet?

If you have other animals, list type, age & sex:

If you have other animals, list type, age & sex:

Have you ever had a dog killed or injured?

Do you have any children under the age of 10 in your household?

If none currently, do you plan on having children in your home?

List any allergies of home occupants:

Where will the dog be kept during the day?

Where will the dog be kept during the night?

Approximately how many hours will the dog be left alone daily?

Is someone home during the day?

Do you have a gender preference?

What age of dog are you interested in? Puppy Young Middle Age Senior

Would you be willing to adopt a deaf dog?

Would you be willing to adopt an OES mix?

Would you be willing to take your OES to an obedience class?

Why do you want an OES:

Mo Kan OLD ENGLISH SHEEPDOG RESCUE, INC
Terms of Adoption

1. Fee: We ask for a minimum donation of $300   The $300 total is due at the time the adoption takes place. The Rescue dog will have been temperament tested, neutered or spayed, have had all the necessary inoculations, a heartworm test, stool test for worms, and medical treatment will be given as needed before the dog is adopted. A complete physical is given as well as the required Rabies shot.
2. AKC Papers: If AKC registration papers are available for the Rescue dog, copies will be given to the new owner.
3. Return Policy: If for any reason, the adoption is not found to be satisfactory, Rescue requires that the dog be returned. The Rescue dog MUST NOT be sold or given away, but returned to Rescue if for any reason the adoption is unsatisfactory for the adopting family. MoKan OES Rescue,  Inc. reserves the right to take back any Rescue dog that is being neglected or not properly cared for.
4. Release Form: The adoptive owner must sign a legal release form protecting themselves, MoKan OES Rescue, Inc., and the Rescue dog.
5. License: The Rescue dog must be licensed in accordance with existing laws in your town, and RABIES vaccine must be kept current.
6. Care: The adopting family agrees to provide adequate shelter, food, all necessary medical and grooming care, and agrees that their Rescue dog will not be allowed to run free or be tied out without proper supervision. Failure to do so will require that the dog be surrendered to Rescue.
We require that you follow a regular inoculation program as established by your veterinarian. Your dog will need yearly boosters for Distemper, Parvo, Kennel Cough. Rabies booster as required by your state law. Your dog MUST have an annual test for heartworm and your veterinarian will recommend a heartworm preventative program for your dog.
I have read the terms of adoption and understand them and agree to abide by them if I adopt an Old English Sheepdog from MoKan OES Rescue,  Inc.