Adoptions Application

Adoption Application

Thank you for taking the time to fill out our questionnaire. The purpose of this application is to learn a little about your family and home so that our organization can make the best possible match for both you and our rescue animal. Our main concern is placing our animals in a compatible home with a family that will give them a LIFETIME commitment of love and proper care. This consultation process is designed to help us determine if the adoption is in the best interest of both the animal and the adopter. Please be aware that while completing this application does not bind you to adopt one of our animals, neither does it guarantee that we will place one of our animals in your home at this time. If you are interested in learning more about one of our rescue animals, please answer the questions honestly and thoroughly.

Some animals may need some extra time and patience to adjust to yet another new home. Some may need housetraining or other types of training, and some may just need a little extra love and patience. All animals, regardless of their background and history, go through an adjustment period when they go to a new environment. There will be a period of a few days, weeks or in some cases months during which your new pet’s personality is emerging and growing while you get to know one another. In order to help you and your pet get through this transition period as smoothly as possible, we will help you in any way possible. Please remember that this is a stressful time for an animal and hopefully we will be able to work together to make this a lifetime relationship for you and your rescue pet. You can call on us at any time to help you in any way. With this in mind, please answer the questions on the application to the best of your ability.

We reserve the right to refuse adoption to anyone for any reason. A representative of our group may conduct home visits prior to or following an adoption, and our group has the right to reclaim an animal following an adoption if unsuitable home conditions, evidence of neglect, abuse or other mistreatment of the animal are found on said visit.

IN ORDER TO BE CONSIDERED AS AN ADOPTER, YOU MUST:

Be 21 years of age or older.

Have identification showing your present address.

Have the knowledge and consent of your landlord.

Be able and willing to spend the time and money necessary to provide training, medical treatment and proper care for a pet for the entire life of that animal.

Thank you for taking the time to answer our questions. We hope that by going through this process, we will reduce the chance of an inappropriate match both for you and for our animals. If you have any comments regarding this adoption application or our adoption process, please feel free to let us know as we are always looking for ways to improve! Again, thank you for considering a rescue pet and saving a life.

About You You must be 21 years of age
Name and Age:
e-mail Address:
Spouse/Partner:
How many people currently live at your residence?
Are there children and if so, what are their ages?
How long at Current Address
Major Cross Streets			and
Street Address:
City, State, Zip:			,
Home Phone:
Work Phone:
Cell Phone:
Best time to contact you:
Occupation:
Name of the Dog you are interested in adopting:
History of Pet Ownership
Do you currently have an Aussie?			Yes No
If yes, describe:
If not, how much knowledge do you have about the breed? (Please explain)
Why do you want to adopt a special needs dog?
Have you ever had to relinquish a pet?			Yes No
If so, under what circumstances?
What pets currently live in your household? (Please list)
Name	Breed	Gender		Age	How long	Spay/Neuter
						Yes No
						Yes No
						Yes No
Do you have any other animals? If yes, please list:
Other than the animals previously described, what other pets have you had in the last five years? For each, please tell us the type of animal and what happened to him or her
Preferences
Do you have a gender preference?			Male Female No Preference
Do you have an age preference?			0-6 Mo 6mo-2yrs Adult No Preference
Are you willing to work with:			Deaf Blind Deaf&Blind Visual Impairments		Yes No Yes No Yes No Yes No
Are you willing to work with a new pet on any issues he or she may have?			Yes No
What behaviors would be unacceptable to you?
What actions would you take to correct these behaviors?
Characteristics you are looking for in your new pet:
Care and Responsibility
Will you be able to take the dog for veterinary/eye care appointments?			Yes No
Are you prepared to do the necessary routine care such as eye drops, daily medication, etc.?			Yes No
Approximately how many hours a day will the dog be left alone?
Where will the dog stay when you are away?
Where will the dog sleep at night?
What, if any, is your dog experience?
What, if any is your experience with special needs dogs, ie: deaf or blind?
About Your Home
Which of the following best describes your current residence? (check one) Own a single family home Rent/lease a single family home or duplex Own a townhouse or condominium Rent/lease an apartment, townhouse or condominium
Other - please explain
Does your lease or Homeowners Association (HOA) have any covenants or restrictions on pet ownership?			Yes No
If yes - please explain:
If you rent/lease can you provide a letter from your landlord describing pet stipulations, type and numbers?			Yes No
Landlord’s Name:
Landlord’s Number:
Do you have a yard?			Yes No
Is your yard, or a portion of your yard, securely fenced and with what type of fencing?
How high is your fence?
Do you have a dog door?			Yes No
If you have a pool is it fenced?			Yes No No Pool
If you have a separate dog run, is it secure?			Yes No No separate run
Would you be willing to let a representative from Amazing Aussies visit your home for a home check?			Yes No
References: Please provide three names including your vet. Other references could include a neighbor or co-worker.
Name of Vet		Phone Number		How long have you been with this Vet

Name of Reference		Phone Number		Relationship to Applicant


Please enter any additional comments or questions have here that you feel would be helpful to us in processing your adoption application:
Adopter's Statement of Commitment I acknowledge that all the information contained on this form is true and correct. I understand that any misrepresentation of fact may result in the removal of the adopted dog from my/our home. I am aware that I must notify Amazing Aussies within 24 hours if the situation should arise in which I can no longer keep the animal. Should an un-neutered or un-spayed dog be placed with me, I agree to have it altered by the date agreed upon by me and the Rescue representative. I also agree that this dog will reside in my home. I will provide the dog with adequate food, water, shelter, training, affection and medical care and the dog will not be tied out or on a run. Fencing will be in place or some other form of containment, as agreed upon. I understand that AMAZING AUSSIES, is not responsible for the accuracy of information received about the temperament, habits or physical condition of dogs available for adoption. However, all information provided is given in an effort to do the best in knowing a dog prior to adoption. Please date and type name in the area below, this serves as your signature.
Name:			Date: