We adopt only to California residents.

Adoption Application
The answers you give on this application will help us to find the best possible match between you and the dogs available through NorCal Aussie Rescue, Inc. We suggest you read About Aussies: Is an aussie right for you? before filling out the application. Please fill out the form completely. This form cannot be processed without a phone number.

* Name

* Home Phone * Work Phone

* Email

* Address

* City * State Choose one Alaska Alabama Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming * Zip

Name of a Personal Reference (not a family member, please!)

Phone Relationship

Do you own or rent your home? Own Home    Rent

If you rent, do you have your landlord's permission to keep a dog? Yes    No

Landlord's Name Landlord's Phone

Do you live in a... House    Apartment    Trailer    Other:

How long have you lived at this address?

Do you have a fenced yard? Yes    No

Fence Height Fence Type

Do you have a separate kennel run? Yes    No

Kennel Height Kennel Size

How many adults in household? How many children?

Age and sex of children (if applicable)

Are there regular visitors to your home (human or animal) with which your new dog must get along? Yes    No

If so, please describe

If you have livestock or farm animals, please list the types

Do you own other dogs? Yes    No

If so, which have been neutered/spayed?

Give breed, sex and age of each

Do you own cats? Yes    No If so, how many?

Do you own other animals? Yes    No

Name of regular Veterinarian

Vet Phone

Vet Address

City State Choose one Alaska Alabama Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Zip

How many dogs have you owned in the last five years?

List breeds and indicate if you still own the dogs

For dogs you no longer own, what happened to them? (please be specific)

Have you owned an Australian Shepherd before? Yes    No

Why do you choose the Australian Shepherd?

Plans for this dog... Pet    Guard    Hunting    Herding    Agility    Obedience    Other:

How many hours a day on the average will the dog spend alone (without humans)?

Where will the dog spend the night? Loose Indoors    Crate    Basement    Garage    Fenced Yard    Kennel Run    Tied up outdoors    Loose Outdoors    Other:

How active a dog are you looking for? Above Average Activity Level Average Activity Level Below Average Activity Level (couch potato)

If you are interested in a particular dog, which one?

And if so, where did you hear about the dog? (please be specific)

If you are already working with a particular rescue rep, which one?

Do you understand this dog must be spayed or neutered? Yes    No

Do you agree to license this dog and give regular health care? Yes    No

Do you agree to contact NorCal Aussie Rescue if you can no longer keep this dog? Yes    No

Would you be willing to let a representative visit your home by appointment? Yes    No

If not, why not?

Describe your ideal Aussie and what types of activities you would do with him/her:

How did you hear about us? **To verify you're a human: I have a sister named Liz and a brother named Tom. Which is my female sibling? Please erase this text and put your answer. If you do not answer this question your form will not be sent to us.

By submitting this application, I declare that all of the above information I have given is true and complete.