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INTAKE Application For a Dog in Need of Rehoming or Rescue

In order to assist you and to advertise your Icelandic Sheepdog in need of a new home on our website, NISRA must first receive the following questionnaire with full disclosure of any behavioral or pre-determined health issues, and a payment in the amount of $30 via PayPal-Credit Card or Check made payable to NISRA.
We would appreciate that if the identified dog is currently in a shelter or placed in a foster home affiliated with another rescue group, that all known information about the dog be forwarded to us.

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Please choose which situation applies to you and your dog:

Breeder Information:

NISRA Due Diligence Policy

If the owner does not know their dog's breeder or the breeder has not been contacted, NISRA will make every attempt to determine who the breeder is and/or contact them regarding the rehome/surrender of one of their dogs prior to any placement.

Please indicate if you are the dog's breeder or owner or you this dog has been surrendered to you:

Owner Information:

Name
Address
Selected Value: 0

Dog Information:

Selected Value: 0
If no microchip then indicate "none"
Breed:
Obedience trained
Crate trained
House trained
Exercised/walked regularly
Good traveling in a car
Friendly to people
Good with young children
Good with other dogs
Good with cats
Exhibits separation anxiety
Exhibits fears or phobias
If yes, please explain below
Destructive in home
If yes, please explain below
Does the dog have a bite history or ever shown signs of aggressive or possessive behavior?

Dog's Health:

Please indicate which vaccines the dog is up-to-date on:
Has the dog been tested for heartworms?
Is the dog on Heartworm medication?
Has the Dog been tested for Lyme Disease?
Does the dog have a current veterinarian?

Owner Commitment:

Are you willing and able to take the dog back should a placement be unsuccessful?
Can someone else take the dog back in your place?
I have reviewed and understand the details of the surrender process and fees involved as outline on the NISRA website and/or surrender form:

Agreement with NISRA:

This questionnaire has been completed to the best of my knowledge. I have disclosed all medical and/or behavioral history in regards to the above-mentioned dog and agree to make NISRA aware of any changes with medical or behavioral history immediately.

By signing this questionnaire, I agree to the following:
Upon receipt of this completed and signed request to re-home/rescue an Icelandic Sheepdog, NISRA will contact individuals who have submitted applications to foster/adopt an Icelandic Sheepdog. NISRA will also post your dog’s information on the appropriate web page and social media in order to assist in re-homing/rescuing your dog.

If your dog must be surrendered immediately, NISRA will make every effort to find an immediate Foster for your dog.

If you are willing to keep your dog until a suitable home is found, you retain ownership of your dog until he/she is re-homed. It will be up to you and the adopting party to come to an agreement regarding re-homing, including but not limited to all transportation, veterinary services, cost, etc.

If help with transportation is needed, NISRA is willing to contact volunteers who may be able to assist with transportation.

Clear Signature

Privacy Policy Confirmation
Ticking this box and submitting this form, you confirm that you understand the following:

This form collects your name, email address, phone number and other personal information to allow us to communicate with you now and in the future. For more information please see our Privacy Policy.

Privacy Policy Confirmation
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