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Western Australian Shepherd Rescue
APPLICATION FOR CANINE GUARDIANSHIP
return by email: [email protected]
Name (guardian)___________________________________________________________________
Co-Guardian______________________________________________________________________
Dog interested in__________________________________________________________________
Address __________________________________________________________________________
City_______________________________________ State______________ Zip_________________
Phone Number_________________________ Email_______________________________________
Occupation/employer______________________________________________________________
Veterinarian reference__________________________________ Phone_______________________
Personal reference__________________________________ Phone__________________________
Rent/own? ______ Landlord_____________________________ Phone_______________________
House________ Townhouse_______ Apartment_________ Other___________________________
Fenced yard?______ Type, size, height_________________________________________________
How will dog be restrained outside if no fenced yard? ____________________________________
__________________________________________________________________________________
Number and ages of children in household (full and part time) _____________________________
__________________________________________________________________________________
Number and ages of adults in the household (full and part time) ___________________________
__________________________________________________________________________________
Pets in household. Provide Types, age, gender, spayed/neutered___________________________
__________________________________________________________________________________
How many hours a day will your dog be alone? ______________________________________
Who will care for your dog in case of emergency/vacation/etc.____________________________
_________________________________________________________________________________
Describe a typical day in your dog’s life _______________________________________________
________________________________________________________________________________
Describe your dog’s day and night living arrangements ________________________________
________________________________________________________________________________
What is your training plan for your dog?
Basic Obedience_____ Canine Good Citizen_____ Good Manners classes_____ Agility_____
Nosework_____ Herding_____ Lure Coursing_____ Flyball_____ Clicker training_____
Tricks and Games training_____ No Plan_____ Self-Training/Other (describe below) ______
__________________________________________________________________________
__________________________________________________________________________
Activities you participate in that may include your dog:
Hiking______ Walking_____ Jogging/Running_____ Swimming_____ Boating/Kayaking_____
Couch potato and other household chores_____ Frisbee/fetch/etc._____ Biking_____
Dog sports (agility/nosework/herding/etc.) _____ Camping_____ Farm/ranch work_____
Urban Lifestyle-parks/brewpubs/restaurants/farmer’s markets/dog friendly shopping/etc._____
Other (please describe) ___________________________________________________________
Your level of experience as a dog owner:
Expert_____ Experienced_____ Novice/Beginner_____
Experience comments: _____________________________________________________________
________________________________________________________________________________
Have you had previous experience with rescue dogs?
Herding dog breeds_____ Guardian dog breeds_____ Other breeds_____ No_____
Rescue experience comments: ________________________________________________________
_________________________________________________________________________________
Under what circumstances would you consider surrendering your dog? ___________________
_________________________________________________________________________________
Gender Preference: Male_____ Female______ No preference_____
Age Preference: Senior (8+ years)_____ Adult (3-8 years)_____ Teen (18 months-3 yrs)_____
Puppy (up to 18 months)_____ No age preference_____
Preferred Temperament: Mellow couch potato_____ Moderate Energy_____ Active go-getter_____
Engaged but somewhat laid back_____ I’m up for any temperament_____ Other (describe below) ____
Temperament preference comments_____________________________________________________
__________________________________________________________________________________
Would you consider a special needs dog such as one that requires daily medication? ________
When are you prepared to adopt? Now_____ Later (specify date/month) _____________________
Do you agree to a home visit? __________
A rescue dog MAY have experienced an unfortunate history of one or more of the following: neglect, abuse, abandonment, loneliness, insecurity, distrust. A period of adjustment (days for some dogs, weeks for others) should be expected. Providing kind, consistent love and care to the new dog will help them learn to trust and relax into their new home. With time most rescue dogs become loyal, affectionate, eager to please, and wonderful companions.
Western Australian Shepherd Rescue's adoption donation ranges from $400-$650 to help with the costs of spay/neuter, vaccinations, heartworm test, microchip ID, and other administrative and foster care costs we incur. Depending on location of the dog, a transport fee may be added to the adoption fee. The rescue donation is due at the time of placement. Submission of your application does not guarantee placement of a dog. Applicants must agree to a home visit if asked for one.
I understand that any misrepresentation of fact may result in the removal of the placed dog from my home.
I understand that Western Aussie Rescue is not responsible for the accuracy of information received about the temperament habits or physical condition of dogs available for adoption. Western Aussie Rescue is neither liable nor responsible for any damage, injury or accident resulting from the placement of this dog. I will accept the responsibilities for the health, housing, feeding, training and companionship of this dog.
Dog's name__________________________ Description___________________________________
Guardian's signature________________________________________________________________
Date_______________________________
By entering your full name above along with the date it is assumed to be a valid signature as if it was handwritten.
Please fill out and save a copy of this application and email to: [email protected]
Western Australian Shepherd Rescue
APPLICATION FOR CANINE GUARDIANSHIP
return by email: [email protected]
Name (guardian)___________________________________________________________________
Co-Guardian______________________________________________________________________
Dog interested in__________________________________________________________________
Address __________________________________________________________________________
City_______________________________________ State______________ Zip_________________
Phone Number_________________________ Email_______________________________________
Occupation/employer______________________________________________________________
Veterinarian reference__________________________________ Phone_______________________
Personal reference__________________________________ Phone__________________________
Rent/own? ______ Landlord_____________________________ Phone_______________________
House________ Townhouse_______ Apartment_________ Other___________________________
Fenced yard?______ Type, size, height_________________________________________________
How will dog be restrained outside if no fenced yard? ____________________________________
__________________________________________________________________________________
Number and ages of children in household (full and part time) _____________________________
__________________________________________________________________________________
Number and ages of adults in the household (full and part time) ___________________________
__________________________________________________________________________________
Pets in household. Provide Types, age, gender, spayed/neutered___________________________
__________________________________________________________________________________
How many hours a day will your dog be alone? ______________________________________
Who will care for your dog in case of emergency/vacation/etc.____________________________
_________________________________________________________________________________
Describe a typical day in your dog’s life _______________________________________________
________________________________________________________________________________
Describe your dog’s day and night living arrangements ________________________________
________________________________________________________________________________
What is your training plan for your dog?
Basic Obedience_____ Canine Good Citizen_____ Good Manners classes_____ Agility_____
Nosework_____ Herding_____ Lure Coursing_____ Flyball_____ Clicker training_____
Tricks and Games training_____ No Plan_____ Self-Training/Other (describe below) ______
__________________________________________________________________________
__________________________________________________________________________
Activities you participate in that may include your dog:
Hiking______ Walking_____ Jogging/Running_____ Swimming_____ Boating/Kayaking_____
Couch potato and other household chores_____ Frisbee/fetch/etc._____ Biking_____
Dog sports (agility/nosework/herding/etc.) _____ Camping_____ Farm/ranch work_____
Urban Lifestyle-parks/brewpubs/restaurants/farmer’s markets/dog friendly shopping/etc._____
Other (please describe) ___________________________________________________________
Your level of experience as a dog owner:
Expert_____ Experienced_____ Novice/Beginner_____
Experience comments: _____________________________________________________________
________________________________________________________________________________
Have you had previous experience with rescue dogs?
Herding dog breeds_____ Guardian dog breeds_____ Other breeds_____ No_____
Rescue experience comments: ________________________________________________________
_________________________________________________________________________________
Under what circumstances would you consider surrendering your dog? ___________________
_________________________________________________________________________________
Gender Preference: Male_____ Female______ No preference_____
Age Preference: Senior (8+ years)_____ Adult (3-8 years)_____ Teen (18 months-3 yrs)_____
Puppy (up to 18 months)_____ No age preference_____
Preferred Temperament: Mellow couch potato_____ Moderate Energy_____ Active go-getter_____
Engaged but somewhat laid back_____ I’m up for any temperament_____ Other (describe below) ____
Temperament preference comments_____________________________________________________
__________________________________________________________________________________
Would you consider a special needs dog such as one that requires daily medication? ________
When are you prepared to adopt? Now_____ Later (specify date/month) _____________________
Do you agree to a home visit? __________
A rescue dog MAY have experienced an unfortunate history of one or more of the following: neglect, abuse, abandonment, loneliness, insecurity, distrust. A period of adjustment (days for some dogs, weeks for others) should be expected. Providing kind, consistent love and care to the new dog will help them learn to trust and relax into their new home. With time most rescue dogs become loyal, affectionate, eager to please, and wonderful companions.
Western Australian Shepherd Rescue's adoption donation ranges from $400-$650 to help with the costs of spay/neuter, vaccinations, heartworm test, microchip ID, and other administrative and foster care costs we incur. Depending on location of the dog, a transport fee may be added to the adoption fee. The rescue donation is due at the time of placement. Submission of your application does not guarantee placement of a dog. Applicants must agree to a home visit if asked for one.
I understand that any misrepresentation of fact may result in the removal of the placed dog from my home.
I understand that Western Aussie Rescue is not responsible for the accuracy of information received about the temperament habits or physical condition of dogs available for adoption. Western Aussie Rescue is neither liable nor responsible for any damage, injury or accident resulting from the placement of this dog. I will accept the responsibilities for the health, housing, feeding, training and companionship of this dog.
Dog's name__________________________ Description___________________________________
Guardian's signature________________________________________________________________
Date_______________________________
By entering your full name above along with the date it is assumed to be a valid signature as if it was handwritten.
Please fill out and save a copy of this application and email to: [email protected]