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Please note that HeRD of WY is staffed entirely by volunteers and application approval may take approximately 2 weeks.

Our adoption procedure is as follows:

1) Submission of application

2) Review of application and contacting of references

3) In depth discussion with foster home and/or rescue director about the dog(s) applied for to be sure that the dog will be a good match for the home and vice versa.

4) Home check (if out-of-area we will arrange to have a rescue or individual in that area complete the home visit).

5) Potential adopters meet with dog(s) and decide if they wish to adopt that dog.

6) Adoption: signing of contract, adoption donation, and a trip home with your new family member.

7) Follow-up support as needed.

Herding Rescue Dogs (HeRD) of Wyoming

APPLICATION FOR CANINE GUARDIANSHIP

Return by email to Joan Adsit:

WyoASR@gmail.com

DATE_________________

1. Name (guardian)__________________________________

Address______________________ City ____________ State______ zip______

Home phone___________________, Work phone_________________,

Cell phone____________________, email________________________

2. Dog(s) interested in (if specific) _________________________

3. Breed preference (Check all that apply)

Other (Corgi, Kelpie, Sheltie, German Shepherd, Collie, etc) _________________

4. Do you prefer

5. What age range do you prefer? _______________________

6. Occupation/employer_________________________________________

7. References: Please provide the name and number for your current or past veterinarian as well as three personal references.

Personal references may include close friends, dog trainers, neighbors or someone who knows how you are with dogs. Please

use no more than 1 relative and no household members.

Veterinarian reference: _______________________phone______________

Personal reference #1: _______________________ phone_____________

Personal reference #2: _______________________ phone_____________

Personal reference #3: _______________________ phone_____________

8. Landlord___________________ phone__________

9. type, size, height____________________________

size___________, when used?__________________

10. Number of children in household (full and part time.) ______

ages and genders___________________________

11. Number of adults in the household (full and part time.)_____

names, age, and genders__________________________________________

12. Number of other dogs______, cats______ , other small animals_________

Names, breed, age, gender (spayed/neutered?) of all pets___________________

13. Primary caregiver of this dog___________________________________

14. How will this dog be exercised?_________________________________

15. Where will the dog stay at night?________________________________

16. Where will the dog stay during the day?___________________________

17. Will you use a tie-out, cable, or chain to restrain your dog outside?_____

18. Is there an adult home during the day?______________

19. Do you plan to take this dog to obedience training? ____

20. Do you own a pickup truck?______ If so, where will the dog ride? ______________________

21. Who will care for your dog in case of emergency? Vacation?

_________________________________________________________

22. How many hours a day will your dog be alone?__________________

23. Activities you participate in that will include your dog:

24. Please indicate (check all that apply) the training methods you use/will use:

25. Level of experience with dogs?_________Have you had previous experience with rescue dogs? _____

If so, please explain:__________________________________________________________________

26. Do you intend to provide your dog with a loving home for the rest of his/her life? ____________

27. What characteristics do you expect of this dog? ____________________________

28. Under what circumstances would you consider surrendering your dog? _____________

29. Please list names, types, and ages of all pets you have had in the last 5 years that you no longer have and what happened to them:

________________________________________________________________________________________________

30. Preferred activity level:

31. What brand of dog food do/will you feed? _____

32. Are you prepared to adopt: (date)________

33. Do you agree to a home check?__________

34. Would you be interested in serving as a foster home for a dog?

35. Any additional comments you would like to share with the individuals or committee

reviewing your application:

A rescue dog MAY have experienced an unfortunate history of one or more of the following: neglect, abuse, abandonment, loneliness,

insecurity, distrust. A period of adjustment (days for some, weeks for some) should be expected in some instances. In either case, a rescue

dog is almost always grateful, loyal, very affectionate, eager to please and very companionable.

HeRD of Wyoming asks for a rescue donation /adoption fee between $125 and $250 to help cover the costs of spay/neuter,

vaccinations, microchip ID, and other office, foster and transport costs we incur.

Submission of your application does not guarantee placement of a dog. Applicants must agree to a home visit if asked for one. The rescue donation

is due at the time of placement.

I understand that any misrepresentation of fact may result in the removal of the placed dog from my home. I understand that HeRD

of Wyoming is not responsible for the accuracy of information received about the temperament habits or physical condition of

dogs available for adoption. HeRD is neither liable nor responsible for any damage, injury or accident resulting from the placement

of this dog. I will accept the responsibilities for the health, housing, feeding, training and companionship of this dog.

My typed signature below indicates I have read and agree to the terms stated above and authorizes the rescue to contact the references I have provided.

Guardian's signature____________________________ Date____________