Your Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth

Date of birth may be left blank

MM

DD

YYYY

Phone *

(###)

###

####

Do you have previous Australian Cattle Dog / Herding Dog experience?

Yes

No

Have you lived at your current address for more than 2 years? *

Yes

No

Previous Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you planning to move in the near future? *

Yes

No

Unsure

Residence *

Own

Rent

Other

Landlord's Phone Number

(###)

###

####

Type of Residence *

Apartment

Condo

Single Family Residence

Multi Family Residence

Townhouse

Other

What setting do you live in *

Country

City

Suburban

Farm

Do you have a doggie door? *

Yes

No

Do you have a backyard *

Yes

No

If Yes, then is it fenced in

Yes

No

Fence Type

Permanent

Temporary

Fence Height

3FT

4FT

6FT

Fence Material

Chain Link

Wooden

Vinyl

Other

Is your fence buried to prevent digging out

Yes

No

Do you have a pool? *

Yes

No

Type of Pool

Above-ground

Underground

Is the pool fenced in

Yes

No

Will you send pictures of home / yard? *

Yes

No

May we do a home visit, if necessary? *

Yes

No

Are you active military *

Yes

No

Are you currently employed? *

Yes

No

Do you work from home?

Full-time

Part-time

Occasionally

Never

Will the Australian Cattle Dog / Herding Dog go to work with you?

Yes

No

Sometimes

Address 2

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Work Phone

(###)

###

####

Do you have a spouse / partner? *

Yes

No

Spouse/Partner

First Name

Last Name

Spouse/Partner Date of Birth

This may be left blank

MM

DD

YYYY

Spouse/Partner Phone

(###)

###

####

Are they active military

Yes

No

Are they employed?

Yes

No

Do they work from home

Full-time

Part-time

Occasionally

Never

Will the Australian Cattle Dog go to work with them

Yes

No

Sometimes

Spouse/Partner's Employer's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Spouse/Partner's Employer's Phone Number

(###)

###

####

Are you adopting the Australian Cattle Dog for you or someone else? *

Myself

Someone Else

In the event of a pregnancy/birth/adoption would the Australian Cattle Dog be returned to the rescue? *

Yes

No

Do any members of your household have pet/environmental allergies? *

Yes

No

Are all members of household agreeable to adopting?

Yes

No

Where will your Australian Cattle Dog live? * *

Inside

Outside

Inside/Outside

Is it:

Heated

Cooled

Will you attend obedience class(es)? *

Yes

No

Do you own a crate? *

Yes

No

Most of our rescues will be crate trained. Will you continue crate training *

Yes

No

How many hours per day will the Australian Cattle Dog be left alone? *

0 to 3 Hours

3 to 6 hours

6 to 8 hours

8 to 10 hours

10 to 12 hours

More than 12 hours

Have you read the information we provide about Australian Cattle Dogs on our website? *

Yes

No

Have you thoroughly researched the Australian Cattle Dog breed? *

Yes

No

Would you consider a dog with special needs? *

Yes

No

Are you able to commit to the 16yr+ life of an Australian Cattle Dog? *

Yes

No

Are there other pets in the home? *

Yes

No

Resident animal(s) good with new ACD?

Yes

No

Will you submit this 'permission' to the rescue? *

Yes

No

Are current pets spayed / neutered and up to date on vaccines?

Yes

No

Is heartworm prevention given monthly and year round?

Yes

No

Veterinarian phone number?

(###)

###

####

Are you financially able to care for an Australian Cattle Dog? *

Yes

No

Are you open to suggestions of meeting? *

Yes

No

Applying for a male or female? *

Male

Female

Either

Have you applied to another rescue group? *

Yes

No

Do you support other rescue organizations?

Yes

No

Rescues (dogs) may have unknown history, acceptable? *

Yes

No

Select the age you are looking to adopt:

Adult 1-6 Years

Senior 7 years +

May we contact the following 3 references? *

Yes

No

Relative Reference *

First Name

Last Name

Relative Reference Phone Number

(###)

###

####

Non Relative Reference Name *

First Name

Last Name

Non Relative Reference Phone

(###)

###

####

Name *

First Name

Last Name

Phone

(###)

###

####

Have you contacted our rescue by phone? 989-330-5147 *

Yes

No