Name

YOUR EMAIL ADDRESS*

Street Address

City

State

Zip

Phone (best number to reach you at)

Have you ever owned an OES before? Have you ever owned an OES before? Yes No

Prefer Male or Female OES? Prefer Male or Female OES? Male Female

Preferred age range (check all that apply) Note: most of our rescue dogs are aged 3 to 5 Preferred age range (check all that apply) Note: most of our rescue dogs are aged 3 to 5 puppy up to 1 year old over 1 year over 6 years

If rent your home/apartment, please enter landlord's phone number:

What attracts you to an OES?

Do you have other pets in the house?

If you have other pets, are they spayed or neutered?

Are your other pets spayed/neutered?

What other dogs have you had in the past 5 years?

Number of adults in your home?

Do you have children in the home? Do you have children in the home? Yes No

if yes, how old are your children?

Do you babysit for other kids? Do you babysit for other kids? Yes No

Do you plan on increasing your family in next 5 years? Do you plan on increasing your family in next 5 years? Yes No

Is someone home during the day? Is someone home during the day? Yes No

Is someone home in the evening? Is someone home in the evening? Yes No

Will this be an indoor or an outdoor dog?

Where and how will the dog spend its time?

How will a new dog fit in to your current lifestyle? Please be specific.

Do you have a fenced yard? Do you have a fenced yard? Yes No

Are you willing to install one? Are you willing to install one? Yes No

What type of fence is it and how high is it?

Who will take responsibility for the dog?

Who will care for the dog when the family is on vacation?

Are you willing to crate train a dog? Are you willing to crate train a dog? Yes No

Are you willing to take your dog to obedience classes? Are you willing to take your dog to obedience classes? Yes No

Please provide the name, address, and phone number of your current (or most recent) veterinarian:

When will you be ready to adopt? If not now, when will you be able to take a new dog home?

When your name gets close to the top of the wait-list we will contact you to schedule an interview (please read notes below). Do you have a preferred day/time?

Anything you would like to add?