Name:

Address:

City: State Zip

Home phone: (___) ___-____; Work phone: (___) ___-_____;E-Mail address:_______________

OES wishing to adopt: Male _____; Female _____; Age range: __________

Do you own or rent a home? _______ If renting, does the landlord approve?

Have you ever owned an OES? ______; How long? __________; What happened to the dog?

What attracts you to an OES?

What other pets do you have ?

Are they spayed/neutered? ________ sex? _____; age? _______

Have you had other dogs in the past 5 years? If YES, please tell us more about them.

Who is living in the home? Adults Children (ages):

Do you baby-sit for other children?

Do you plan on increasing your family within the next 5 years?

Do you have a fenced yard?______ Type: ________________; Height: _________

If not, are you willing to install one?

Is someone home doing the day? _______ Is someone home in the evening? _______

Will this be an inside dog or an outside dog?

Where and how will the dog spend its time ?

Who will take responsibility for the dog?

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

Are you willing to take your dog to obedience classes?

Are you willing to kennel crate train a dog? ______________

Will you kennel crate the dog when you're away from the house and at night for at least six months? ________

Please provide the name, address, and phone number of your current or most recent Veterinarian.

In order for you to adopt an OES from this program, it is necessary for you to have a personal interview with one of our Rescue Committee members. The purpose of this interview is to acquaint you with our breed, its problems and feeding requirements. When would you like to schedule this interview?

Mail Completed Form to:

Jim McDaniel

3323 Cason

Houston, Texas 77005

Signature: _________________________________; Date: ____________