Zip code *
Phone number *
Preferred method of contact and best time of day to reach you (Morning/Afternoon/Night)
Are you the legal owner of the dog?
Name of dog needing placement assistance
How long have you had the dog?
Does the dog have a microchip?
Why are you seeking placement for the dog?
How many times do you feed the dog per day?
What type of food?
Can you provide some of their food if placed?
Has this dog ever shown aggression toward people or other animals including but not limited to an injury bite? (one that left bruised or broken skin)
Were Animal Control or the Police involved?
Did the bite require medical attention?
If yes to any of the above, please explain in detail
If from a Shelter/Rescue Organization/Breeder please complete information below: Shelter/Rescue Organization/Breeder Name
Shelter/Rescue Organization/Breeder Address
Shelter/Rescue Organization/Breeder City
Shelter/Rescue Organization/Breeder State
Shelter/Rescue Organization/Breeder Zip
Shelter/Rescue Organization/Breeder Phone
If there was a Shelter/Rescue Organization/Breeder, have you reached out to them to return your dog? Most adoption contracts contain verbiage that requires you to return the dog to them in the event that you can no longer keep the dog.
If no, Please explain why in detail:
How is this dog with strangers outside of the home?
How is this dog with strangers visiting your home?
How is this dog with women?
How is this dog with men?
How is this dog with children?
How is this dog with other dogs?
How is this dog with cats?
Where is this dog used to spending most of it's time?
How does this dog do on a leash?
Is this dog crate trained?
If the dog is left loose indoors, how is it?
How is this dog during thunderstorms?
Describe what you feel is the best type of home for the dog
Please run through, in detail, a typical day for this dog (where it spends it's time, play/exercise routines, etc.)
Does the dog have any bad habits we should know?
Which traits describe this dog's personality best? (Choose all that apply)
Describe this dog's energy level
What are the dog's favorite activities?
What else can you tell us about the dog?
Veterinarian Clinic Name
Veterinarian Clinic Phone Number
When did this dog last see a veterinarian, if known?
Is your Aussie Spayed/Neutered?
If no or not sure, explain why
Is the dog current on vaccinations?
If no, explain why
Provide month and year of the last rabies vaccination
Provide month and year of last DHLPP
Is your Aussie currently being given HW preventative on a monthly basis?
Provide month and year of the last time HW preventative was given
Provide month and year of the last HW test was conducted by your veterinarian
What were the results of the last Heartworm test conducted by your veterinarian?
Describe any known injurys or known health issues
Is dog current on any medications excluding heartworm and flea/tick preventative? Please list:
I certify that all of the above information is accurate I understand that by filling out this application, I am under no obligation to surrender a dog from ARSC