Protege-Logo
Phone: 319-339-1749
Email: info@protegerescue.org
 
Adoption Application
Adopters are expected to come in person to meet and pick up their dogs; we do not ship dogs.

Your answers on this application will help us find the best possible match between you and the dogs in our care. The more we know, the better the chance your adoption will be successful. All information is confidential. Thank you for your cooperation and help in answering our questions. (If no phone number is given, this application will be rejected.) Submission of this application does not guarantee that you will be approved or receive a dog. An incomplete application or misrepresentation of any facts on this application is grounds for refusal.

WE RESERVE THE RIGHT TO REFUSE AN APPLICANT.

(Note: You may use the TAB key to move to the next field in the form and the Shift-TAB keys to move to the previous field.)

Part 1: Contact Information
 
First Name Last Name
Home Phone
(area-code) xxx-xxxx		 Work Phone
(area-code) xxx-xxxx
Mobile Phone
(area-code) xxx-xxxx		 Email
Street Address
City State/Province
Country Zip/Postal Code
Best time to call
Preferred Number
Home Work Mobile
Are you currently working with another Aussie rescue organization? Yes No
If you are currently working with another organization:
Which organization?
Who are you working with?
Have you completed an application form for this group? Yes No
Have you adopted a Protege dog before? Yes No
If so, which dog and when?
If you have adopted a Protege dog before, you may initial, date, and submit this application now. We will be in touch if we need additional information.
 
 
Part 2: References
Please provide contact information for two people who know you and your dogs; if you don't have dogs, two people who could vouch for you. Consider dog trainer, personal friend or co-worker, someone involved with you in dog activities, neighbor, etc.
 
Name of Personal Reference #1 (not a family member, please!) Relationship
Phone Best time to call
Email

 
Name of Personal Reference #2 (not a family member, please!) Relationship
Phone Best time to call
Email
 
 
Part 3: Residence Information
 
Do you own or rent your home?
Own Rent
 
If you rent:
Do you have your landlord's permission to keep a dog? Yes No
Is there a size limit? Yes No
If yes, how many pounds?
Landlord's Name Landlord's Phone
(area-code) xxx-xxxx
 
Do you live in a...
House Apartment Trailer Other
If "Other", please describe
How long have you lived at this address?
If less than one year, how long at previous address?
Do you have a fenced yard? Yes No
If you don't have a fenced yard, how will you handle
the dog's exercise and toilet duties?
 
If you have a fenced yard:
Fence height Fence type
Does fencing completely enclose a yard for the dog? Yes No
 
Do you have a separate kennel run? Yes No
 
If you have a separate kennel run:
Kennel height Kennel size
 
 
Part 4: Family Information:
 
What is your occupation? How long at present job?
If less than one year, how long at previous job?
How many adults in household? Occupations?
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, describe
Are all family members in agreement about adopting a dog? Yes No
Does anyone in your family have pet allergies? Yes No
Who will provide the majority of care for this dog?
When you go on vacation, where will your dog go and who will care for it?
If you move, what will you do with your dog?
What conditions or circumstances would cause you to give up a dog?
 
 
Part 5: Other Pets/Pet Background
 
Do you own other dogs? Yes No
List name, breed, gender, age, and spay/neuter status of all dogs currently owned
Do you own cats? Yes No
If so, how many?
Are they spayed/neutered? Yes No
Are they accustomed to dogs? Yes No
If you have livestock or farm animals, please list the types
Do you own other animals? Yes No
If so, please list types
Once your dog arrives, how long do you think it needs
for an adjustment period?
Are you aware that if you adopt a dog from Protege Canine Rescue,
you are required to return the dog to us if you can no longer keep it?		 Yes No
How many dogs have you owned in the last 10 years?
For dogs you no longer own, what happened to them?(be specific)
Name of regular veterinarian
Vet's Phone
Vet's Clinic Name & Address
How long have you been with this vet?
If no vet, provide a reason
 
 
Part 6: Adopting a Dog
 
What breed(s) are you interested in adopting from Protege Canine Rescue?
Australian Shepherd Other Breed No Preference Breed
Why are you interested in this breed(s) of dog?
Is there anything about this breed(s) that might be an issue for you?
Have you owned a similar breed(s) of dog before? Yes No
If not, why do you want to adopt one now?
What qualities are you looking for in your future dog?
Plans for this dog...(check all that apply)
Pet Guard Hunting Herding Obedience Agility Flyball Other
If "Other", describe
Do you want to adopt...
Male Female No preference
Color preference Size preference
Age preference
Under 1 year 1-3 years 4-7 years 8+ years Special Needs No Preference
I have marked my preferences above, but would be willing to
consider a suitable dog of a different... (check all that apply)
Gender Color Size Age
Where will dog spend the day? (check all that apply)
Loose indoors Crate Basement Garage Fenced yard Kennel run Tied up outdoors Loose outdoors Other
If other, describe
How many hours on the average will the dog spend alone?
Where will dog spend the night? (check all that apply)
Loose indoors Crate Basement Garage Fenced yard Kennel run Tied up outdoors Loose outdoors Other
If other, describe
How active a dog are you looking for?
Above Average Activity Level Average Activity Level Below Average Activity Level (Couch Potato)
Describe your ideal dog
Describe a typical weekday for your dog
(If you have no dog, describe how you imagine a typical weekday would be)
Describe a typical weekend for your dog
(If you have no dog, describe how you imagine a typical weekend would be)
Are you over 18? Yes No
If under 18, are your parents agreeable to adopting a dog? Yes No
 
 
Part 7: Specifics/Next Steps
 
If you are interested in a particular Protege Canine Rescue 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 Protege Canine Rescue requires this dog
be spayed or neutered?		 Yes No
Do you agree to license this dog (if required in your community)
and to provide regular health care?		 Yes No
Do you agree to contact Protege Canine Rescue
if you can no longer keep this dog?		 Yes No
Would you be willing to let a representative of Protege Canine Rescue visit your home by appointment? Yes No
If not, why?
How did you hear about us?
(Using a web search engine? On another Rescue site? From a person?)
 
Protege Canine Rescue is a 501(c)(3) non-profit rescue service. Approved applicants who receive a rescue dog are required to pay a $200 adoption fee. Thanks for your interest in our volunteer organization.

I hereby affirm that all of the above information is true and correct. I understand that submission of this application does not necessarily mean that I will be approved to adopt and that you reserve the right to reject any applicant. I authorize you to verify any and all information set forth in this application and to contact my personal and veterinary references.

By submitting this application, I declare that all of the above information I have given is true and complete.
Initials
Date
We cannot process your application unless you initial and date your application.

Please review your application to ensure it has been filled out completely, then press the Submit button below which will forward your application form to Protege Canine Rescue for processing. Incomplete forms will be rejected immediately. Please do not submit the form until you have completed it. Once you have successfully submitted the form, please do not submit it again.