Placement Application


	Shiloh Rescue Network

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If you have an ISSR registered Shiloh that you need to rehome, we're here to help!

1. Are you certain you want to rehome your dog? We have resources to help with behavior, training and other problems. Our first choice is always to help you with your work better with your dog, rather than having to rehome your dog.

2. If you must rehome your dog, please fill out the following request for placement. We need as much information on the dogs as we can possibly get to insure a good match with the dog's future owner. As of October 22, 2004, no dogs will be posted on the Shiloh Rescue Network website without having this form completed. It would be a great help if you could provide a few good pictures of the dog also. Please e-mail them in .jpg format to Debbie AFTER you have sent in the following form.

Shiloh Rescue Network -- Placement Application

Are you the legal owner of this dog? Yes No
If not, how did you obtain this dog?

* REQUIRED INFORMATION

*Name:
*Address:
*City:
*State:           *Zip-code:

*Email address:

*Home phone (including area code):
Work phone (including area code):
Cell phone (including area code):
Best time to call:

Registration Information About This Dog:

Dog's registered name: Call Name:
Spayed Female Intact Female Neutered Male Intact Male

ISSR Registration Number: Date of Birth:
Breeder:

Was this dog sold to you as a Breeding     Show   Upgradeable Pet Non-Upgradeable Pet
Is there a co-ownership on this dog that needs to be satisfied by law?   Yes No
Co-Owner's Name (if any): Co-Owner Phone:
Have you notified the co-owner that this dog is being re-homed through the Rescue Network?
Yes No   Not Applicable

Color/Markings, other identifiable marks:
Coat Type: Plush Smooth

Is dog tattooed or microchipped? No Yes
What is the number and/or microchip brand:

If not purchased from a breeder, where did you obtain this dog?

Veterinary Information:

Name of your Veterinarian: Phone:
Address:

Date of the last visit to the vet:
Is dog up to date on vaccinations? No Yes Don't Know
What vaccinations have been given?

Has this dog ever been vaccinated for rabies? No Yes When?

Date of last heartworm test? Positive Negative
If the dog is on heartworm preventative, what kind is it?
How often does the dog receive HW preventative? (daily, weekly, monthly, etc.)
Date of last dose:

Does this dog have any known health problems?

Is this dog on any type of medications:

How much, how many times per day:

Temperament & Training Information:

Were there any children in the home with the dog? No    Yes
If so, please list their ages:

How was the dog's behavior with the children? (check all that apply)
Friendly     Playful     Aloof     Timid     Fearful     Aggressive
Protective Overly Protective    Herded/Nipped at them
Other (please specify):

How was the dog's behavior with the primary owner, or the one person it was most attached to? (check all that apply)
Friendly Playful Aloof Timid Fearful Aggressive
Protective Overly Protective Herded/Nipped at them
Other (please specify):

How was the dog's behavior with the visitors (adults and children)? (check all that apply)
Friendly Playful Aloof Timid Fearful Aggressive
Protective Overly Protective Herded/Nipped at them
Other (please specify):

How was the dog's behavior with the delivery people, mail carriers, people working in yard, on your house, etc? (check all that apply)
Friendly Playful Aloof Timid Fearful Aggressive
Protective Overly Protective Herded/Nipped at them
Other (please specify):

Was this dog kept primarily as: (check all that apply)
Companion pet Protective family dog Guard dog Other (please specify):

What type of training has the dog had?
None Basic Obedience Advanced Obedience Agility Search and Rescue
Therapy Dog Protection/Schutzhund CGC
Other (please specify):

What type of environment was the dog raised in?
Rural Small town Suburban City

Did the dog live in a: House Condo/Townhouse Apartment
Other (please specify):

Was the dog primarily kept: Indoors Outdoors Both

Did the dog have access to use a doggy door from the house to the yard? No Yes

Did the dog have access to play in a fenced yard? No Yes

Where did the dog spend a majority of it's time? Loose in the house Crated in the house
Loose in fenced yard Chained in the yard In a kennel run
Other (please specify):

If the dog spent time in a fenced yard or kennel, what was the height of the fence at the lowest point (in feet)?

Did the dog ever jump the fence to escape? No    Yes
Did the dog ever unlatch the gate to escape? No    Yes
Did the dog ever dig under the fence to escape? No    Yes

Does the dog enjoy swimming? No Yes

Was anyone home all day long with the dog? No Yes
How many hours per day was the dog routinely left alone?

What brand of food do you feed this dog:
How much and how many times per day:
Any special preparations?

Has this dog ever bitten anyone? No Yes Within the last ten days? No Yes
Who?
Describe any biting incident:

Please check all that apply:

Raised with Children (give ages below)                          Good with children
Good with other dogs (both male and female)                 Barks/growls at new dogs
Good with only male dogs                                             Chases small animals/cats
Good with only female dogs                                           Has had obedience training
Friendly with all people                                                 Is good left alone in house
Barks at strangers, then makes friend                             Chews things up if left alone
Aloof but non-aggressive to strangers                           Digs when outside
Fearful or avoids strangers                                           Good with cats
Protective of home, but will make friends if asked to       Rides well loose in the car
Aggressive with strangers                                             Rides well crated in the car
Excessive barker/howler                                                Gets carsick
Sleeps on furniture                                                      Has occasional accidents in the house
Counter surfs or steals objects                                       Never has accidents in the house
Runs away if off-lead                                                   Used to being outside (loose & unfenced)
Used to a fenced yard                                                   Used to being outside (tied)
Escapes from fenced yard                                              Used to being outside (Kennel)
Used to invisible fencing                                                Used to being leash walking
Escapes from invisible fencing                                        Pulls on leash when walked
Can remove food/toys from mouth - without the dog objecting Crate trained
Food / toy possessive or aggressive                                         Afraid of thunder or loud noises
Used to going up and down full flights of stairs

Please explain any exceptions to items checked above or other behaviors we should know about (example: fear of thunder) :

Is this dog well behaved with and used to being handled by: Veterinary staff Groomer

Is this dog:
Trick trained Housetrained (housebroken and good house manners) Leash Trained Crate Trained

What commands does this dog know? Sit Down Stay Come No Heel

What tricks or other commands does this dog know?

How do you discipline this dog? Yell Say No Gentle hitting Time out in crate Leash corrections
Other - Please describe why and how you would discipline your dog:

Why are you giving this dog up?

Please use this area to provide any additional information that you feel would help us find a home for your dog.

I hereby state that I/we are the legal owner(s) of the above described dog and that there are no other parties that may have a legal interest in this dog. In that I can no longer care for this dog, I hereby request the Shiloh Rescue to assist me in the placement of this dog, understanding that by doing so I am relinquishing all claims to this dog. I understand that this surrender and release of my ownership rights in this dog is irrevocable. I state and affirm that to the best of my knowledge, the above information is accurate and complete, and that I have not failed to disclose any information about this dog that might result in the harm of any person or other animal. I understand and agree that if I have not made full disclosure about any known bites, I hold the Shiloh Rescue harmless and indemnify the Shiloh Rescue for any legal damages resulting from the dog’s undisclosed propensity to bite.

Please type your initials on the line to the left to signify your consent:

(Initial here) I understand and agree that I am requesting the assistance of the Shiloh Rescue to place this dog, via adoption, and that it is of my own free will and that such surrender does not constitute a sale. I understand and agree that I will receive no money or other compensation as a result of surrendering this dog.

Dedicated to rescuing and rehoming original ISSR Shiloh Shepherds.

Shiloh Rescue Network