Adoption Questionnaire

 Please fill out the form below as completely as possible and
 then email it to the appropriate foster family, who will then get
 back to you regarding the status of your application.

Adoption Questionnaire

Please fill out completely, including the following required fields:

  • the foster family email address (ending in “acdra.org”)
  • your email address

    • don’t forget to hit the “Submit Query” button at the bottom of the page!

    Enter the ACDRA Email Address (ending in “acdra.org”) to receive this application:
    (this field is mandatory)

    How did you learn about our Rescue?

    What made you choose this breed as the dog for you?

    Have you ever owned an Australian Cattle Dog?

    Name:

    Last: First: Initial:

    Street Address:

    City: , State: Zip:

    Your Email Address (this field is mandatory):


    Phone Number:

    Employer Name:
    Employer Phone: Employed how long?

    Spouse/Housemate Name:

    Last: First: Initial:

    Spouse/Housemate Employer Name:

    Employer Phone: Employed how long?

    Please list three references and phone numbers:


    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 and ages:

    Do the children live there full-time? If not, when?

    Do you have tenants or other relatives living with you?
    Do you live in a ?
    Do you own your home?
    If renting, do you have WRITTEN permission to house a dog on the premises?
    You must provide us with a copy of this written permission

    Do you have a yard? If yes, is the yard fenced?
    If yes, does a house door open into the fenced area?
    Fencing material used: If other, please specify:
    Specify height of fence and linear dimensions:
    How many gates? Height of Gates:
    Are the gates kept locked?

    Do you have secure screens on all your windows?
    Will the dog be primarily:
    Where will the dog sleep at night?
    What shelter will be provided outside? If 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?

    What is the primary reason you are considering an ACD?

    Do you have a preference for 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 spayed/neutered? If no, please explain:


    Please list all animals you presently own:
    Animal/Breed                  How obtained                    Time Owned        Sex    S/N?    Vacc?


    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: Phone:
    Address:

    What is the activity level in your home?

    If you have previously owned pets, please fill in the chart below:
    Animal/Breed                  How obtained                    Time Owned        What Happened to Pet?


    Under what circumstances would you NOT keep the pet?
    If Other, please specify:

    An immediate health check is essential for the welfare of the dog and your own peace of mind. This needs to be done within the first five (5) working days of taking your dog home. Considering the high cost of veterinary are, are you willing and able to afford the necessary medical care and further vaccinations necessary to keep your dog healthy?

    Have you ever purchased a rescue dog in the past?
    If so, did you encounter any problems?
    If yes, please explain:

    Pet ownership is a serious responsibility, therefore the whole family should be involved in the decision to adopt a dog. Our policy is to insure that each person who adopts a dog not only be aware of that responsibility, but that each member of the family be willing and able to accept this responsibility both 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 the ACDRA 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 the following carefully before submitting this form:

    I understand that there will always be an adjustment period for any dog coming into my home. Knowing that this period could be anywhere from three (3) weeks to three (3) months I am committed to work to make this pet a member of the family. I also understand that many of these dogs have survived tremendous odds and needs lots of care and attention.

    I understand that the ACDRA 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 ACDRA reclaims the pet, I waive any claim of trespassing that I might otherwise make arising out of such reclaiming.

    I also agree that if the information given on this questionnaire is not accurate to the best of my knowledge, I forfeit all rights and ownership of the ACD adopted from the ACDRA.

    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 ACDRA for arrangements to be made for the dog’s return to them.

    By selecting "Yes" and and then clicking "Submit query" I confirm that I have read completely the above questionnaire, and understand it fully:

     

    *



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