NYC Shiba Rescue
Shiba Inu Rescue, Fostering, and Adoption in and around New York City
Please list two personal references. If possible, please list individuals who are active in the dog community and are
knowledgeable about your care of dogs, such as a trainer, breeder, active rescue volunteer, etc.
DO NOT LIST FAMILY MEMBERS. DO NOT LIST VETERINARIANS.
The information I have provided in this document is correct and true to the best of my knowledge and I have not withheld any pertinent information. I understand that any misrepresentation of me or my family or any untruths of
the information I have provided herein that are discovered at a later date will invalidate any adoption agreement and will give the rescue the right to reclaim the dog without my permission and without refund of any adoption donation. Submittal of this form provides my agreement to this adoption application.