SHAR-PEI RESCUE COMMITTEE

Send this application to:
Karen Hollis, Rescue Co-ordinator
5484 Bethesda Road, Stouffville, Ontario L4A 7X3
(905) 642-5694 or e-mail: khollis@netcom.ca

Applicant questionnaire

  1. Name:___________________________________________________________________________
  2. Address:_________________________________________________________________________
  3. Telephone:_________________________
  4. E-mail:_______________________________
  5. Do you live in a house, ___ townhouse____ or apartment___?
  6. Any children? Yes____ No ____ ages:__________________
  7. Any other animals, if yes what are they ____________________? male ___female___
  8. Is your yard fenced? Yes_____ No______
  9. Is someone home during the day? Yes______ No_____ # of hours_______
  10. Will the dog be kept indoors ______ outdoors_______
  11. What is the main reason for wanting a dog: companion___ watchdog__ pet___ other____
  12. Have you ever owned a shar pei? Yes___ No_____
  13. If no, why are you interested in a Shar-Pei? _______________________________________________
  14. Any preference in age? Yes__ No___
  15. Are you willing to be placed on waiting list to adopt? Yes___ No___
  16. Are you interested in providing a foster home for a Shar-Pei? Yes___ No ___
  17. If you have owned dogs in the past, what happened to them?_______________________________
        _______________________________________________________________________________
  18. Did you spay/neuter? Yes__ No___
  19. Name of veterinarian: ________________________ Phone:________________
  20. Where will dog stay if you go away?_________________________________________


        ________________________________________________________

    Date & Signature of applicant

Print this application, fill out and mail to the above address and it will be sent to the appropriate representative and they will contact you or e-mail your answers to khollis@netcom.ca

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