On-Line Application Form



Personal Information
First	Last
Address
City	State	Zip
Phone	Cell
e-Mail
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? Yes No
What sex of dog are you looking for?
Will your dog be:
Outdoors Indoors Mostly Indoors Mostly Outdoors
Have you adopted from Aussie Friends Rescue before? Yes No If yes, please list names of dogs:
Have you had pets before? Yes No If yes, please list what types: What happened to them:
How many animals do you currently have?
Do you have a veterinarian? Yes No Enter Hospital Name: Enter Phone Number:
Home and Family
Do you agree to a home visit by Aussie Friends Rescue? Yes No
We Own Rent
We live in a House Apartment Condo Other
If you rent does your landlord allow dogs? Yes No
Does your residence have a dog door? Yes No If not, will you be installing one? Yes No
Is your yard fenced? Yes No If so, what type of fence? Block Wood Chain Link Other
Does your home have a pool? Yes No If yes, is there a fence enclosing your pool? Yes No
Where will your new dog be kept during the day while you are away? Inside Outside Access to indoors and outdoors Other
Where will your new dog be kept at night? Inside Outside Access to indoors and outdoors Other
Our family's activity level with our pet is: We actively participate in dog sports Very active and always on the go Moderately active, mostly weekend activities Not very active, occaisional walks Someone is always at home, primarily companion at home
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?
References
1st reference
First	Last
Phone	Cell
2nd reference
First	Last
Phone	Cell
By applying to meet a Aussie Friends Rescue dog, I will not hold Aussie Friends Rescue or any member thereof, responsible for any damage, injury or harm caused directly or indirectly by any dog I or a family member may decide to meet at any location. I acknowledge that all the information contained in this form is true and correct to the best of my knowledge. Your Signature:

Please enter code above