Adoption Application - Aussie Rescue of Minnesota

aussie adoption Aussie Rescue of Minnesota, Inc. (ARM) is a non-profit adoption and referral service dedicated to placing Aussies with new, permanent homes. All of the Aussies available for adoption have been temperament tested, spayed/neutered, are current on their shots, and are heartworm checked and/or treated. If a suitable dog is found for you, we do ask for an adoption fee to help us cover any medical work we have done for the dog and to help us continue to help other Aussies in need.

To help us find the best match between you and the dogs we have available, please complete this application. After a representative has reviewed your application, you will be contacted to discuss any dogs we have available that would suit you. Normally a representative will contact you within 3 days of receiving your application. We do, however, reserve the right to refuse any applicant.

Please be patient with any inquiries or applications submitted.

Adoption Notice

Current and/or previously-owned dogs must be up-to-date (UTD) on rabies, parvo, and distemper with a strong history of annual wellness exams, seasonal heartworm prevention and flea/tick prevention. Outdoor cats must be UTD on rabies. Indoor cats’ health care must be adequate. Titer tests are accepted (excluding rabies).

Dog Interest Information

Name of the Dog You are Applying For:

Markings of the Dog You Are Applying For:

Alternative Dog You May Be Interested In IF Primary Interest Is Not Available:

What dog age group are you interested in?

Are you familiar with the Aussie breed? (reference info)
YesNo

Have you previously owned Aussies?
YesNo

Applicant Information

Name:

Street Address:

City:

State:

Zip Code:

Best Contact Phone:

Email:

Applicant age:

Household member names, relationships and ages:

On a scale of 1-10 (1 low key – 10 marathon runner) what energy level do you consider yourself/household?

Do all of the adults in household want a dog?
YesNo

Age & Relationship of the non-household Children the Dog will encounter:

How many dogs are currently in the household?

How did you hear about Aussie Rescue of Minnesota (ARM)?

Are you willing to allow an ARM home visit?
YesNo

The Dog You Are Seeking to Add to Your Family

Why do you want to own an Aussie?

What plans do you have for your Aussie? (pet, guard, obedience, herding, agility, therapy, etc.)

How will you actively include your Aussie?

How will you exercise your Aussie?

How will you socialize your Aussie?

On a scale of 1 (couch potato) to 10 (competitive sports dog), what energy level are you looking for in your Aussie?

Are you willing to train in obedience with your Aussie?
YesNo

How would you handle behavioral problems or issues that might arise?

Have you crate trained in the past?
YesNo

Are you willing to use a crate?
YesNo

On a scale of 1 (no intensity) to 10 (maximum intensity), what level of intensity do you want your Aussie to have?

What traits would your Aussie have that would be deal breakers for your household?

How Will Your Aussie Spend Its Time?

# of hours you/member of your household is home during a 24-hour period

# of hours your Aussie will be left alone during a 24-hour period

Where will your Aussie spend its sleeping hours?

Where will your dog go while you are on vacation?

Vet Information

Vet Clinic

Vet Name

Vet Phone Number

Best Hours to Contact

Name of the Person the Vet Records are Listed Under

Vet Clinic #2

Vet Name #2

Vet Phone Number #2

Best Hours to Contact Vet #2

Name of the Person the Vet #2 Records are Listed Under

References

** At least 1 of the 3 personal references must be for a non-family member **

Reference #1

Name:
Phone:
Email:
Relationship:

Reference #2

Name:
Phone:
Email:
Relationship:

Reference #3

Name:
Phone:
Email:
Relationship:

Current Dog Information

Dog #1

Name:

Age: years months

Breed

Sex N/AMaleFemale

Spayed/neutered N/AYesNo

Weight (lbs)

On a scale of 1-10 (1 is couch potato, 10 is good to compete in sports), what activity level is dog #1?

Please check all boxes for traits that apply to dog #1:
CalmAffectionateAgileAnxiousCuriousNervousRambunctiousCuddlyPatientFunPlayful with humansPlayful with DogsHyperSleepyVocal/BarkerWatchfulFriendly with humansFriendly with dogsRespectfulRough playerGentle playerObedientAggressiveStubbornComicalLoyalVelcroJumps upon greetingCounter SurferEnjoys the outdoorsHas off switchReactive on a leashWell socializedDigger

On a scale of 1-5, dog #1 is:
1 = needs significant work
5 = outstanding

Good with human strangers? N/A12345No Exposure
Good with other dogs? N/A12345No Exposure
Good with cat(s)? N/A12345No Exposure
Good with livestock? N/A12345No Exposure

Date of last Rabies Vaccination for Dog #1

Date of last Parvo Vaccination for Dog #1

Date of last Distemper Vaccination for Dog #1

Date of last Heartworm Exam for Dog #1
No Heartworm (last 12 months)

Name of Heartworm Prevention Medicine Used for Dog #1:

Name of Flea/Tick Prevention Used for Dog #1

Dog #2

Name:

Age: years months

Breed

Sex N/AMaleFemale

Spayed/neutered N/AYesNo

Weight (lbs)

On a scale of 1-10 (1 is couch potato, 10 is good to compete in sports), what activity level is dog #2?

Please check all boxes for traits that apply to dog #2:
CalmAffectionateAgileAnxiousCuriousNervousRambunctiousCuddlyPatientFunPlayful with humansPlayful with DogsHyperSleepyVocal/BarkerWatchfulFriendly with humansFriendly with dogsRespectfulRough playerGentle playerObedientAggressiveStubbornComicalLoyalVelcroJumps upon greetingCounter SurferEnjoys the outdoorsHas off switchReactive on a leashWell socializedDigger

On a scale of 1-5, dog #2 is:
1 = needs significant work
5 = outstanding

Good with human strangers? N/A12345No Exposure
Good with other dogs? N/A12345No Exposure
Good with cat(s)? N/A12345No Exposure
Good with livestock? N/A12345No Exposure

Date of last Rabies Vaccination for Dog #2

Date of last Parvo Vaccination for Dog #2

Date of last Distemper Vaccination for Dog #2

Date of last Heartworm Exam for Dog #2
No Heartworm (last 12 months)

Name of Heartworm Prevention Medicine Used for Dog #2:

Name of Flea/Tick Prevention Used for Dog #2

Dog #3

Name:

Age: years months

Breed

Sex N/AMaleFemale

Spayed/neutered N/AYesNo

Weight (lbs)

On a scale of 1-10 (1 is couch potato, 10 is good to compete in sports), what activity level is dog #3?

Please check all boxes for traits that apply to dog #3:
CalmAffectionateAgileAnxiousCuriousNervousRambunctiousCuddlyPatientFunPlayful with humansPlayful with DogsHyperSleepyVocal/BarkerWatchfulFriendly with humansFriendly with dogsRespectfulRough playerGentle playerObedientAggressiveStubbornComicalLoyalVelcroJumps upon greetingCounter SurferEnjoys the outdoorsHas off switchReactive on a leashWell socializedDigger

On a scale of 1-5, dog #3 is:
1 = needs significant work
5 = outstanding

Good with human strangers? N/A12345No Exposure
Good with other dogs? N/A12345No Exposure
Good with cat(s)? N/A12345No Exposure
Good with livestock? N/A12345No Exposure

Date of last Rabies Vaccination for Dog #3

Date of last Parvo Vaccination for Dog #3

Date of last Distemper Vaccination for Dog #3

Date of last Heartworm Exam for Dog #3
No Heartworm (last 12 months)

Name of Heartworm Prevention Medicine Used for Dog #3:

Name of Flea/Tick Prevention Used for Dog #3

I have more than 3 dogs: YesNo

Current Cat Information

How many cats are currently in the household?

Cat #1

Cat #1 Name:

Cat #1 Age: years months

Indoor Cat or Outdoor Cat? N/AIndoorOutdoor

Cat #1 spayed/neutered? N/AYesNo

Cat #1 Traits (check all that apply):
CalmAffectionateAgileAnxiousCuriousNervousRambunctiousCuddlyPatientFunPlayful with humansPlayful with DogsHyperSleepyVocal/BarkerWatchfulFriendly with humansFriendly with dogsRespectfulRough playerGentle playerObedientAggressiveStubbornComicalLoyalVelcroJumps upon greetingCounter SurferEnjoys the outdoorsHas off switchReactive on a leashWell socializedDigger

Cat #2

Cat #2 Name:

Cat #2 Age: years months

Indoor Cat or Outdoor Cat? N/AIndoorOutdoor

Cat #2 spayed/neutered? N/AYesNo

Cat #2 Traits (check all that apply):
CalmAffectionateAgileAnxiousCuriousNervousRambunctiousCuddlyPatientFunPlayful with humansPlayful with DogsHyperSleepyVocal/BarkerWatchfulFriendly with humansFriendly with dogsRespectfulRough playerGentle playerObedientAggressiveStubbornComicalLoyalVelcroJumps upon greetingCounter SurferEnjoys the outdoorsHas off switchReactive on a leashWell socializedDigger

I have more than 2 cats: YesNo

Previous Dog Information

How many dogs have you had in the past 10 years?

If you don't have them any more, why not?
Deceased – old ageDeceased – illnessDeceased – accidental deathRehomed to a friend/familySurrendered to rescue or shelterOther – please explain

if other, please explain:

Home Information

Do you own your home?
YesNo

If no, please provide landlord name, phone number, and email:

Landlord's name:

Landlord's phone:

Landlord's email:

Size of Lot

Do you have an enclosed yard (i.e., fence, etc)?
YesNo

If you have a Fence, what type is it:
N/AWood PrivacyWrought IronVinylStoneChain LinkCoated Chain LinkOther

If fence type is "Other", please explain:

Fence Height (N/A if no fence):

If no fence, how do you handle your Aussie’s bathroom needs?

Additional Information

Any additional information that would be useful to quickly reach the best match for you and an ARM dog:

If the dog is placed with me/us, I/we agree to cooperate with ARM in its attempt to provide a smooth adoption. I also agree to contact ARM about problems that may arise in the future. Should I/we become unable to care for the dog, I/we agree to contact ARM immediately and return the dog immediately for placement elsewhere.
Please check box to you accept the above statement: