Australian Cattle Dog Rescue of Illinois

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Adoption Application

* REQUIRED INFORMATION
If some are not applicable to your situation, please put n/a in the blank.
If you don't answer ALL questions, your application is denied.

*Are you familiar with the ACD Breed?

*Do you have Australian Cattle Dog experience? If not, why are you interested in adopting this breed? Explain why you would be a good ACD rescue parent.
(If filling out for a breed other than a cattle dog, please note that here.)
* Your Name:
* Your Age:
* Spouse/Partner Name:
* Address:
* City:
* State:
* Zip:
* Email:
* Home Phone:
* Other or Cell Phone:
* Employer:
* Employer Address:
* Work Phone:
* Work Hours:
* Spouse/Partner Work Hours:

*List all members living in your home and their ages:
* Do you have young children visit on a regular basis? (i.e. grandchildren, babysitting)? If yes, ages of children:
* Are you expecting a child, or planning a family in the future? If yes, will the Australian Cattle Dog remain in the home?
* How long have you lived at this address:
* Previous Address if less than 2 years:
* Number of Years at Previous Address:
* Is everyone in your home agreeable to adopting a rescued dog and training a rescued dog? If not, who and why?
* For whom are you adopting the pet? If someone else, please explain for whom. Do they know?
* Does anyone in your home have any known allergies? If so, please explain.
* In the event of your sudden demise, who would immediately care for your adopted rescue?
* Which of the following terms best describes your current living situation? Own House, Rent House, Own Condo, Rent Condo, Rent Apartment, Own Modular Home, Rent Modular Home, Living with Parents, Living with Others:
* If renting, landlord's name and phone number:
* Social environment (city, suburban, country)? Briefly explain:
* Does your city or county have a limit of pets per household? If so, what is the limit of pets allowed per household?
* Does your home have a backyard?
* Is your yard fenced? If so, what is the type and height of fence?
* Will dog be left alone during the day? If so, where will dog be kept and for how long?
* Specifically, what will be the dog's living situation? (ex.: run of the house, outside kennel, garage, basement):
* If outside, describe fencing, kennel, house, ex: heated and/or cooled?
* Where will the adopted dog sleep?
* Will you attend obedience training with your adopted dog?
* If not attending obedience training with your adopted dog, how much time will be devoted to daily training?
* If you have a preference of a male or female, please specify:
* Age Range:
* Why do you want this rescued dog? What are your expectations?
* What activities are you going to engage in with your adopted dog?
* How long will you keep this dog? What if there is a major lifestyle change, or if the dog becomes ill, will the dog be given up?
* Are you willing to adopt a dog with special medical needs, such as daily eye drops, special diet or daily medication?
* What do you consider behavioral problems?
* Are you willing to adopt a rescue dog with behavioral issues, such as house training, jumping on people, barking, etc.?
* What is your method of disciplining a dog?
* Do you own a crate, and what are your thoughts about crating?
* Will you be able to continue the crate training (good for housebreaking, boarding, hospital stay)as the rescue is used to?
* Are there other pets living in your home? (if not, skip this section):
* What brand food do you feed (or will you feed)?
* If you have an animal now, have you ever introduced it to a new animal? If yes, how did your pet react?:
*List breed(s), age(s), and sex(es)of current/past 3 pets:
* Are all other pets current on all vaccinations?
* Are other pets spayed and/or neutered?
* If no to either above, please explain:
* If necessary, will you spay or neuter your current dog?
* Are other pets on heartworm preventative?
* If yes, brand:
* If no, explain:
* Veterinarian's Name (that you plan to use for your new pet):
* Vet's Phone:
* File name of each of your pet(s) and owner (if different) in case we call the vet office:
* Have you attended obedience training with your current or previous pets? If so, trainer's name:
* Do any of your current pets have behavioral issues? Or, have you had a pet with issues? If so, what issues and how do you handle it?
* Please list any rescued dogs posted on our Australian Cattle Dog Rescue available pages that you are currently interested in:
* Are you willing to travel to pick up your adopted rescue dog? If yes, how far are willing to travel?
* Have you applied to adopt from another rescue group? If yes, which group?
* Do you understand that often times the complete history of a rescued dog may not be known? Is this acceptable?
* Please provide the name, email address and phone number of two (2) references. Relative Reference

Non-Relative Reference
I declare that the information I have provided in this application is complete and correct. I further declare that I am financially and physically able to care for a rescued dog. I understand that proper food and veterinarian care may be costly, and I am able and willing to meet the needs of my adoptive dog. I understand the requirements and grant permission for Home Checks at random both prior to and following adoption. I submit that if the Adoption Application or the Home Check reveals falsification or misrepresentation of any facts on my part, Australian Cattle Dog Rescue of Illinois reserves the right to either refuse adoption or to nullify the adoption and reclaim said rescued dog from my premises, without reimbursement of the adoption donation. I release Australian Cattle Dog Rescue of Illinois from any liabilities I may incur from the adoption process.

I understand that if I need training advice, I will ask the rescue for suggestion. I also agree the dog will never be taken to a "kill shelter" or Humane Society or given away without offering back to this rescue service first.

By submitting this application you are agreeing to the above declaration.
* Please print your name again, to be used as a signature on this form. Signature:

Date:
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Australian Cattle Dog Rescue of Illinois
Post Office Box 53
Texico, Illinois 62889
Phone: 618-315-8800


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