Todays Date * First Name * Last Name * Street Address * E-mail Address: * City * State * Zip code * Home Telephone * Fax Number Work and/or cell phone * Work Hours * Occupation * Spouse/Partners name Spouse/Partners Occupation Referred by Veterinarian * Vets Address/Phone * Do you rent or own your home * Rent Own Is it single family, condo or apartment * Single Family Condo Apartment Do you have fencing? * Yes No What type of fence? (wood, chain link, etc) * Is your fenced area attached to the house? * Yes No Does it have a door leading into the house? * Yes No If not, are you willing to comply with Rescues fencing or leash policy? * Yes No Why do you want an Old English Sheepdog? * Have you ever owned a dog before? * Yes No Please describe what kind(s). * What happened to your last pet? * How long did you have this pet? * If you have other animals, list type, age, sex * List ages of children living at home * Where will dog be kept during day? * Where will dog be kept at night? * How many hours will the dog have to be alone? * Is someone home during the day? * Yes No Are you willing to take the dog to obedience class * Yes No Indicate preference for Male, Female or No preference * Male Female No preference What age range? * Under 5 years 5 years or more Any Age When are you available for a personal interview? * Any further comments? Are you willing to travel to meet &/or pick up dog? * Yes No * Required