Tri-State Shiba Inu Rescue (Application)

Items marked * must be answered

Which Dog are you Interested In?

About You

*First Name

*Last Name

Address

*City

*State

Zip Code

*Phone (xxx.xxx.xxxx)

*email

*Age

Occupation

*Do children live here or visit? Yes No

About The Dog You're Looking For

Pure Bred Rescue

Male Female

Shiba

Shih Tzu

Age Range

*Will the dog be kept mainly Indoors Outdoors

*Will the dog be Crated Confined to a specific area Allowed free run

*How long will the dog be alone daily

*Do you have other pets

Dog(s)

Cat(s)

Other

*Have you previously owned dogs?
Yes No

Will you allow a home vist upon request?
Yes No

Please describe what you are looking for in a pet, any behavior issues you would consider okay, and if
you would consider a “special needs dog”?

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