On-Line Application Form

Personal Information
First Last
City State Zip
Phone Cell
Please provide the names and ages of all adults and children
living in your household. (separate by commas)
Pet Interest and Information
Name(s) of dogs you are interested in:
What age or age range of dog were you looking for? 
Are you willing to accept mixed aussies? 
What sex of dog are you looking for? 
Will your dog be:
Have you adopted from Aussie Friends Rescue before?
If yes, please list names of dogs:
Have you had pets before?
If yes, please list what types:
What happened to them:
How many animals do you currently have?  
Do you have a veterinarian?
Enter Hospital Name:
Enter Phone Number:
Home and Family
Do you agree to a home visit by Aussie Friends Rescue?
   We live in a   
   If you rent does your landlord allow dogs?
   Does your residence have a dog door?
     If not, will you be installing one?
   Is your yard fenced?
     If so, what type of fence?        
   Does your home have a pool?
     If yes, is there a fence enclosing your pool?
   Where will your new dog be kept during the day while you are away?
   Where will your new dog be kept at night?
   Our family's activity level with our pet is:
When you are out of town, what do you plan to do with your dog?
What are your work hours? Is anyone else home while you work?
How much do you expect, or are you willing to spend on medical expenses per year for your dog?
What is your plan if you can no longer take care of your pet due to health, moving, or other reasons?
1st reference
First Last
Phone Cell
2nd reference
First Last
Phone Cell

Your Signature:
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