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Woody’s Place ~ Senior German Shepherd Sanctuary, Inc. 21 Leah Lane, Waymart, PA 18472 www.SeniorGSSantuary.com Wpsgss@gmail.com 570 - 267-2737 Adoption Application/ Questionnaire Saving lives of senior German Shepherds Woody’s Place ~ Senior German Shepherd Sanctuary (WP~SGSS) is dedicated to saving the lives of, caring for, and rehoming senior German Shepherds to the best of our ability. In order to help us match you, the potential adopter, with the most suitable senior German Shepherd for your family and lifestyle please take the time to complete this questionnaire and mail it along with a non refundable $25 application fee to Woody’s Place. 21 Leah Lane * Waymart, PA 18472. (Please make check or money order payable to Woody’s Place ~ Senior German Shepherd Sanctuary. If you are submitting this application/questionnaire on line through our web site or as an attachment in an e mail please pay through Paypal. Please answer every question thoroughly. The more accurate the information that you provide us with the better we will be able to match you with a senior German Shepherd in our program. Once we review your complete application we will provide you with a list of the potential senior German Shepherds we feel are a good match for you to consider. Please keep in mind that although you may be applying with a particular senior German Shepherd in mind that you may have seen on our web site or on line, we make no promise that that particular dog is still available or would be considered a good match for your home. Before you fill out this form please know that we ask for an adoption donation for each dog, and donations are what helps us help the dogs. Once we agree on a suitable senior for you the $25 processing fee will be applied to the adoption donation. All dogs will be up to date on shots, and spayed or neutered whenever possible. 8-10 years old: $150.00 10 - 12 years old $100.00 12 years and up: $50.00 Please understand that it may take some time for us to make a connection between you and a senior German Shepherd candidate that we feel would best match for you and your lifestyle based on the information you provide us with. If in the mean time your circumstances change and you no longer wish to adopt though WP~SGSS please let us know. Today’s Date: Adopter(s) Name: Adopters(s) Address: Day Phone# Evening Phone # Cell# E mail Address: Driver’s License # State of Issue ______________________________________________________________________________ Section A. Information as to what you are looking for in a senior German Shepherd 1. Do you have any preference as to the “sex” of the senior German Shepherd? (Check one only) Male Female No Preference 2. Do you have a preference as to the color of the senior German Shepherd? Black and tan Black and red Black and silver Black Sable Bi-color White No Preference 3. Do you have a preference as to the age of the senior German Shepherd 8 to 10 10 to 12 12 and up 4. Do you have a preference as to bone structure? Big boned (90lbs or more) Medium (70lbs or more) On the smaller side (less than 70lbs) 5. Why are you interested in a senior German Shepherd? 6. To assist us in matching a dog to you, please pick three characteristics that you deem most important in your new senior German Shepherd. “1" being the most important. active Independent Shy/docile calm Submissive Loving Playful friendly Protective Intelligent good with other pets Good with kids Healthy ______________________________________________________________________________ Section B. Your Household and Lifestyle 7. Which of the following best describes your current residence. Own a single family home Own a condo/townhouse Own a twin/rowhome/duplex Rent any of the above Live with family (Please note if you rent/lease, you must present a copy of your lease to show proof that you are allowed to have a German Shepherd dog before any adoption can be finalized.) 8. How long have you lived at your current residence? _____years _____months 9.If you have lived at your current residence for less than one year, please provide your previous address. 10 Is your yard fenced in? yard. If no, please explain how you plan to contain your dog to your 11. Do you have stairs in your home? them? If so will the senior German Shepherd be required to use 12. Approximately how many hours each day do you anticipate that your new senior German Shepherd dog will be alone? 13. If more then six hours, what provisions will you make for the dog to relieve itself and get a little exercise in your absence? 14. How many people currently live in your household, including you? Please state who they are, their relation to you, and their ages. 15. Who will most likely spend the greatest amount of time with the senior German Shepherd? 16.Who will most likely be financially responsible for the care of the senior German Shepherd? 17. If you are a single person and travel often who will care for the senior German Shepherd during your absence? 18. Does anyone in your household have any known or suspected allergies to animals? If yes, please explain. ______________________________________________________________________________ Section C. Your Current and Prior Pet Ownership 19. What other animals currently live in your household? Please list and explain each one Name Type of pet Sex Age Length of ownership Kept where 1. 2. 3. 4. 5. 20. Are all of your current dogs and or cats spayed or neutered? If no, why not? 21. Have you ever owned a German Shepherd before? Please give a brief history. 22. Have you ever owned a senior German Shepherd before? Please give a brief history. 23. Do you have a current veterinarian or is there one that you have used in the past if you currently do not have any pets? Please provide name and address and length of time you used the veterinarian for. 24. If you currently have a veterinarian will you continue to use this vet for the senior German Shepherd? If no, please explain why not. 25. Have you or anyone living in your household ever been investigated by any animal welfare organization, including the S.P.C.A, Human Society etc.? If yes, please explain. 26.Have you or anyone living in your household even been charged with cruelty to animals? If yes please explain. 27. What is your current occupation? Please provide us with your employer’s phone number and address. 28. How long have you held your current occupation? 29.Please list the name, phone number (including area code), and address of 3 personal references. Please list how long you have known them for. *We will not except family members as a personal reference. 1. 2. 3. 30. Please list the names of animal organization, clubs, etc. to which you belong or whom you donate your time and/or money to. ______________________________________________________________________________ D. Information for WP~SGSS 31. How did you find out about WP~SGSS? Please indicate source and a name if you have one. EX. name of shelter, contact name or Internet/ website, or Pet store/fundraiser. 32.Would you consider volunteering for WP~SGSS? If yes, please check what volunteer activities you would be interested in performing. Fostering dogs Evaluating dogs Other Transporting dogs Fund-raising events Telephone calling Computer assistance Adoption application processing Home checks ______________________________________________________________________________ As a part of the adoption process and before placing any dog, you will be asked to sign an adoption contract in which you agree to certain conditions, including keeping the dog as in “indoor” house pet, maintaining regular veterinary care, including annual shots, allowing a WP~SGSS representative to visit your home before and/or after placement of the dog, and finally, surrender the senior German Shepherd back to WP~SGSS in the event you are no longer willing to keep the dog or violate the contract in anyway. Are you willing sign and to adhere to the terms of the contract? Yes or No. I/We have carefully read and answered each question on this Adoption Application/Questionnaire and have provided truthful answers. I/We understand that WP~SGSS will rely on the answers we have provided in going forward with the adoption process and, in the event that WP~SGSS learns that false information has been given, we may be denied the right to adopt a dog and/or any dog placed in our care by WP~SGSS will be returned to us, and all fees paid to us will be forfeited. We also understand that we may be denied the right to adopt a dog if our references do not meet WP~SGSS standards or if WP~SGSS otherwise determines that our home is not appropriate for a senior German Shepherd. Finally, we understand that the $25 we have submitted with this application in non refundable. ______________________________________________________________________________ ____________________________ Adopter’s Signature ____________ Date ____________________________ 2nd Adopter’s Signature ____________ Date ____________________________ ____________ Dawn Mimnaugh Or Corette Stahley Date President and Vice President of Woody’s Place ~Senior German Shepherd Sanctuary Thank you for considering Woody’s Place, and saving the life of a senior German Shepherd. One of our volunteers will be in contact with you after reviewing your application.

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