EmailMeForm
Midwest Shiba Inu Rescue - Adoption Application
Please fill out this form if you are interested in adopting a dog from MSIR. Fill out each question completely and accurately as it helps us to match potential homes with rescue dogs in our care.
Contact
adoptions@shibarescue.org
with any questions.
*Please note your application may be shared with other rescuers on a public shiba rescue message list.
Name
*
First
Last
Age
*
Occupation
*
Street Address
*
City
*
State
*
Zip Code
*
Please list the nearest large city
*
Home Phone
###
-
###
-
####
Work Phone
###
-
###
-
####
Cell Phone
###
-
###
-
####
Email
*
Have you ever applied and/or adopted from MSIR in the past?
*
No
Previously applied
Previously adopted
Please explain why you are interested in adopting a shiba.
*
Is there a currently available MSIR dog you are interested in?
Yes*
No
*If yes, please list the dogs name.
Who will the adopted dog be for?
Do you have any children?
*
Yes
No
Maybe in the future
Please list the names and ages of all (human) members of your household:
*
Does everyone in your household want a dog?
*
Yes
No
Describe your home:
*
House
Apartment
Townhouse/Condo
Do you own or rent your home?
*
Own
Rent*
*If you rent, please provide the name and phone # of your landlord. Please describe any size, weight or breed restrictions.
Do you have a fenced-in yard?
*
Yes*
No
*If yes, please describe type and height of fence
Do you have plans to move?
Yes
No
Where will the dog stay when you are away from home?
Indoors
Mostly indoors
Indoors/outdoors
Mostly outdoors
Outdoors
Current Pets
Do you currently have other dogs?
*
Yes*
No
*If yes, please list name, breed, sex & age for each dog.
*Please describe how each dog gets along with other dogs.
Are your current dogs spayed or neutered?
Yes
No*
*If not spayed or neutered, please explain.
Do you currently have any cats?
Yes*
No
Do you currently have any other pets?
Yes*
No
*If yes, please list animal type and age.
Are your current pets up-to-date on vaccinations?
*
Yes
No*
No current pets
Are your current pets on flea/tick and heartworm preventatives?
*
Yes
No*
No current pets
*If not up-to-date on vaccinations or on preventatives, please explain why.
Past Pets
Have you owned dogs in the past?
Yes*
No
*If yes, please list breed, sex and what happened to each dog.
Have you ever had to give up a dog or other pet?
Yes*
No
*If yes, please explain the circumstances.
Veterinarian
Please provide information for a vet reference.*
Name of Clinic
Name of Veterinarian
Address
Phone
*If you don't currently have a vet, please provide a personal reference, preferably a pet reference (previous vet, current or previous obedience instructor, dog walking service, or the humane society for which you volunteer, etc.
Name
Relationship
Address
Phone
Email
Adopting a dog
What dog(s) would you be willing to consider? (check all that apply):
Shiba Inu
Shiba mix
What sex of dog would you be willing to consider:
Males only
Females only
Either
What age of dog(s) are you be willing to consider? (check all that apply):
Puppy - Under 1 year
Young adult - 1-3 years
Adult - 4-7 years
Senior - 8+ years
What color of dog(s) are you be willing to consider? (check all that apply):
Red
Red Sesame
Black & Tan
Cream
What activity level of dog are you be willing to consider? (check all that apply):
Daily walks
Occasional walks
Coach potato
Running
Would you consider adopting a Shiba without meeting them (from out of your area)?
Yes
No
MSIR fosters dogs across the Midwest. How far are you willing to travel to meet a Shiba?
30 miles
60 miles
100 miles
200 miles
200+ miles
Please provide any additional information about yourself, your family, or the dog you are hoping to adopt.
I have provided complete and accurate information.
*
Please select if you agree
Date Submitted
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