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AUSTRALIAN CATTLE DOG RESCUE, INC. (CORPORATION) RESCUE & ADOPTIONS
Confidential Adoption Questionnaire Please fill in completely:
HOW DID YOU LEARN ABOUT OUR RESCUE? _____________________________
HAVE YOU EVER OWNED AN AUSTRALIAN CATTLE DOG? __________________
NAME __________________________________________________________________
SPOUSE/HOUSEMATE ___________________________________________________
STREET ADDRESS ______________________________________________________
MAILING ADDRESS _____________________________________________________
HOME TELEPHONE ____________________
EMPLOYER NAME _______________________________________________________
EMPLOYER TELEPHONE _______________________ EMPLOYED HOW LONG? _______
SPOUSE/HOUSEMATE EMPLOYER NAME __________________________________
EMPLOYER TELEPHONE _______________________ EMPLOYED HOW LONG? _______
PERSONAL REFERENCES: Please list three (3) with telephone #'s
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
How long have you lived at this address? ______________________________
How long do you plan to live at this address? _________________________
How long do you plan to reside in this area? __________________________
Number of children in household & ages _______________________________
Do the children live there full-time? ______ If no, when?
_______________ Do you have tenants or relatives living with you?
______________________ Do you live in a: House ( ) Apartment ( ) Farm (
) Mobile Home Park ( ) Do you own? _____ If renting, do you have WRITTEN
permission to have a house dog on the premises? _____ If yes, please
attach a copy. Do you have a yard that is: Perimeter fenced ( ) Yard
fenced ( ) Does a house door open into the fenced area? ____ Kennel run
( ) No fence ( ) Fencing material used: Block wall ( ) Chain-link ( )
Welded wire ( ) Chicken wire ( ) Wood ( ) Other ( ) Please specify
height of fence and linear dimensions: ___________________ How many
gates? ____ Height of gates? ____ Are they kept locked? _____ Do you
have secure screens on all your windows? ______ Will the dog be
primarily: Inside ( ) Outside ( ) Where will the dog sleep at night?
_____________________________________ What shelter will be provided
outside? Patio ( ) Shed ( ) Doghouse ( ) Garage ( ) Other ( ) Please
specify _______________________________________________________________
Is there shade in the dog's area at all times during the day? __________
Do you have a swimming pool? ____ If yes, is it fenced separately from
the rest of the yard? _____
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What is the primary reason you are considering an ACD? Watch dog ( )
Breeding ( ) Companion ( ) Guard dog ( ) Child pet ( ) Obedience ( )
Herding trials ( ) Ranch work ( ) Do you have a preference of sex, age,
color, personality? ____________________
______________________________________________________________________________
Are there any specific habits or problems that you are not willing to
deal with?
________________________________________________________________________
Do you believe a pet should be spay/neutered? _____ If no, please
explain
______________________________________________________________________________
Please list all animals you presently own:
Breed How & Why Obtained Time Owned Sex S/N Vacc/Lic
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Who is responsible for the care of these animals?
____________________________
If you go away for a few days or on vacation, who will care for these
animals?
_____________________________________________________________________
How many hours a day will the animal be left unattended? _____________
Does anyone in the family have allergies to animals? ___________________
Who is your regular veterinarian? Name/address/telephone#
______________________________________________________________________________
What is the activity level in your home? ( ) Busy-visits by friends,
meetings, children, parties at home ( ) Noisy-T.V., stereo, machinery,
tools, lots of kids playing ( ) Moderate-normal comings and goings ( )
Quiet-"homebodies", few guests
If you have previously owned pets please fill in the chart below:
Breed How & Why Obtained How Long Kept What Happened to Pet
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Under what circumstances would you not keep the pet? New Job ( ) Move (
) New Baby ( ) Divorce ( ) Illness ( ) Other ( ) Please explain
______________________________________________________________________________
An immediate health check is essential for the welfare of the dog and
your peace of mind. This needs to be done within the first three (3)
working days of taking your dog home. Considering the high cost of
veterinary care, are you willing and able to afford the necessary
medical care and further vaccinations necessary to keep your dog
healthy?
______________________________________________________________________________
Will you keep this pet up to date on vaccinations and licensing? _______
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Have you ever purchased a rescue dog in the past? ____ If yes, did you
have any problems? ____ Please explain
_______________________________________
______________________________________________________________________________
______________________________________________________________________________
Pet ownership is a serious responsibility. The whole family needs to be
involved in the decision to get a dog. Our policy is to insure that each
person who adopts a dog not only be aware of that responsibility, but
that each person be willing and able to accept this responsibility
morally, physically, and financially. We have found that not every
person who desires to own an ACD should own one. They are an active and
sometimes aggressive breed, but wonderful in the right home.
This questionnaire was designed to aid both you and us in determining if
you and your family are indeed adequately prepared to assume the type of
responsible pet ownership we are endeavoring to provide for our rescue
dogs.
Please read carefully and sign:
I understand that there will always be an adjustment period for any dog
coming into my home. The average is three (3) weeks to three (3) months
and I am willing to work to make this pet a member of the family. I also
understand that many of these dogs have survived tremendous odds and
need lots of TLC.
I understand that, the Corporation reserves the right to check on the
welfare of this dog on my premises, and to reclaim both possession and
ownership without payment of any kind with or without court action. In
the event I do not comply with the adoption contract provisions and the
Corporation reclaims the pet, I waive claims for trespasser damage that
I might otherwise have arising out of such reclaiming.
I also agree that if the information on this questionnaire is not
accurate to the best of my knowledge, I forfeit all rights and ownership
of the ACD adopted from the Corporation.
I also agree that if at any time in the future I can no longer keep this
dog, I will not give it away or sell it. I will contact the Corporation
for arrangements to be made for the dog's return to it.
I have read completely the above questionnaire, and understand it fully.
Applicant Signature ____________________________________ Date ________

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