ARPH Online Adoption Application

NOTE: Please keep your answers brief, with a limit of 500 characters per answer
*First Name:
*Last Name:
Name & relationship (to applicant) of all other adults in the home:
List the number and ages of children in the home:
*Address:
*City:
*State:
*Postal Code:
Country:
Home Phone: Work Phone:
Cell Phone:  
NOTE: If you do not provide your phone number, your application will be discarded.
Best Time to Call: Preferred Number:
E-mail:
Occupation:
How Long at Present Job? If less than 1 year, please state how long at your previous job?

NOTE: If you currently own a pet or have owned one in the last 10 years, your vet's name is required to process your application. If you cannot supply a vet reference, please give the reason why.
Do you have a regular veterinarian?
 How long have you been with this vet?
Vet Full Name:
Vet Address:
Vet phone number:
If no Vet Reference, please provide a reason:
PERSONAL REFERENCES: preferably those who are familiar with your experience as a pet owner. NO family members please:
Reference 1:
*Full Name:
Relationship:
*Phone #:
Alternate Phone #:
E-mail: Best Time to Call:
Reference 2:
*Full Name:
Relationship:
*Phone #:
Alternate Phone #:
E-mail: Best Time to Call:
 
Do you live in a:
How long have you lived at this address?
Do you own or rent your home?
If renting, do you have your landlord's permission to keep a dog?
Landlord's Full Name:
Landlord's Phone:

NOTE: If renting, you will need to provide a copy of your lease/co-op bylaws to the rescue representative before adoption. If you live in a condominium/co-op, or your house is a part of a homeowner’s association, prior to adoption, you will need to provide a copy of the bylaws, rules and regulations of such association stating that there are no restrictions regarding owning a dog. If there is a limit on the number of pets you are allowed, please note the limit on the copy of the bylaws.
Do you have a fenced yard? Does the fencing completely enclose a yard for the dog?
Fence Height: Fence Type:
If no fence, how do you plan to keep your new dog safe?
Do you have a separate kennel run? List height & size:
 
If you have children, what type of exposure or experience have your children had to dogs and to what breeds:
Who will be the primary caretaker of this dog?
Are there regular visitors to your home (human or animal) with which your new dog must get along? If Yes, Please Describe:
Are all family members in agreement about adopting an Aussie?
Do you own cats? How many? Are they spayed/neutered?
Other Animals in Home?
 
How many dogs have you owned in the last ten years?
For all dogs you presently own, give name, age, sex, breed and if spayed/neutered:
Give name, age, sex, breed, if spayed/neutered, and what happened to all dogs that you have owned in the past 10 years, but no longer have, listing the years you owned them:
List all pets owned in the past 10 years other than those listed above:
 
Does anyone in your household have allergies to dogs:
Have you ever taken a dog for training classes? If so, what type (obedience, agility, conformation, etc.), and did you complete the classes:
How do you plan to train your new dog?
Why do you want an Aussie as a pet?
Have you owned an Australian Shepherd before?
If no, what previous experience, if any, have you had with Aussies?
In your research of the Australian Shepherd, is there anything about the breed that might be an issue for you? Please describe:
List all plans for this dog (i.e. Pet; Guard Dog; Hunting; Obedience; Herding, Agility):
How do you plan to exercise your dog? Please describe:
Where will dog spend the day? (hold Ctrl key to select all that apply)
Please explain "Other":
On average, how many hours will the dog spend without human company each day?
Where will dog spend the night? (hold Ctrl key to select all that apply)
Please explain "Other":
 
What sex do you want to adopt?
Color Preference:
Age Preference:
Size Preference:
I have marked my preference above, but would be willing to consider a suitable dog of a different (hold Ctrl key to select all that apply):
 
Do you understand that ARPH requires this dog to be spayed or neutered?
Do you agree to license this dog and give it regular health care?
Do you agree to contact ARPH if you can no longer keep this dog?
Would you be willing to allow someone designated by ARPH to visit your home by appointment?
If not, why?
 
How did you hear about our rescue efforts? (Website, Facebook, Search engine, Petfinder, Friend, Other rescue, Other ( explain)
In situations where there is no ARPH representative in your area we would like to forward your information to other Australian Shepherd Rescue organizations. May we share your information with other rescue organizations?
I am over 18 years of age
If under 18, my parents are agreeable to my adopting an Aussie.
Please provide any other information you feel would be helpful to us in screening your application:

 

ARPH does ask an adoption fee in order to help us cover expenses incurred. Anything received above that amount is a tax-deductible donation. Please contact your local representative if you have any questions. All of the above information I have given is true and complete. Should an unneutered or unspayed dog be placed with me, I agree to have it neutered or spayed by such date agreed upon by me and an ARPH representative. At that time, I will forward evidence to ARPH that such procedure has been completed.

I further understand and agree that ARPH uses my personal information in order to process my application, including distribution of that information as needed to volunteers of ARPH by email communication and through posts on a closed, password protected Yahoo Group site. ARPH makes reasonable commercial efforts to secure my personal information from unauthorized access, use or disclosure. Unfortunately, however, no data transmission over the Internet is 100% secure. While ARPH strives to protect my information, ARPH cannot ensure or warrant the security of such information.

This dog will reside in my home as a pet. I will provide it with adequate food, water, shelter, training, affection, and medical care. I understand that ARPH is a referral service and is not responsible for the accuracy of information received about the habits, temperament, or physical condition of dogs available for adoption. I understand that it is my responsibility to evaluate the dog for myself before agreeing to adopt it. I am in full agreement with these terms of adoption. ARPH shall not be liable for, and is hereby relieved from, all liability for any damage, expenses, causes of action, fines, suits, demands, judgments or claims of any nature whatsoever arising from or by reason of any damage to property or injury to any persons caused in whole or in part by the dog placed in your home. I hereby accept and assume such liability and agree to protect, indemnify and hold ARPH harmless from and against all of the aforesaid. Submitting this form constitutes your permission for us to check references.

WE RESERVE THE RIGHT, IN OUR SOLE DISCRETION, TO REFUSE ANY APPLICANT FOR ANY REASON WHATSOEVER.
   
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~ I have also read and understood the Terms of Use and Privacy Statement applicable to this website, to which there are links below












   

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