First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone
Work Phone x
Cell Phone*
Farm owners name (if different from above)
Farm name
Do you own or lease
How long have you farmed/lived at this address? If less than one year, please list previous address
Are you within 1/2 mile of a main road/highway
Number of fenced acres:
Fence type, height and condition
What kind of shelter from harsh weather is available to your livestock and LGD(s)?
Type and quantity of livestock to be guarded
What types of predators are in your area?
Do you currently have working LGD’s on your farm? If so, list the breed, age, sex of each LGD, the number and the type of livestock each is guarding
Are there provisions in place to safely introduce your new LGD to the livestock? Please describe
Will your new LGD from Rescue live in a fenced area with the livestock it is guarding?
How many dogs (working and non-working) have you owned in the last five years?
Do you still have them? If not, what happened to them? (Please be specific):
Are/were they spayed/neutered?
Do you provide monthly Heartworm prevention to your LGD’s and/or non-working dogs? Type of Preventative used:
Do you have other pets and are they spayed neutered?
If yes, how are/will they kept separate from your working LGD
Age of children (if any)? Please include visting and/or other children that the dog may interact with.
Will children have unmonitored access to your new LGD?
Are there regular visitors to your home with which your new LGD must get along? Please describe
How close is your nearest neighbor? Will they have a problem with dogs that WILL bark, especially at night?
Gender preference:
Age preference
Veterinarian's Name and Phone Number. Please include the names and phone numbers of ALL vets you have used over the past five years for ALL pets, listing your most current vet first. If you have never used a vet, please let us know.*
By submission of this application, I(we) attest that the information provided on this application is true and accurate to the best of my(our) knowledge. I(We) understand that completion and submission of this application does not guarantee adoption of a dog from Great Pyrenees Rescue Montana or its rescue partners. I(We) hereby permit Great Pyrenees Rescue Montana to contact my(our) Veterinarian(s) and Landlord, if applicable. Please initial*
