Golden Years Alaskan Malamute Rescue

Adoption application

Name: _________________________________________________________________________

Address: ______________________________________________________________________

City, State, Zip: _____________________________________________________________

Phone number: _________________________________________________________________

E-mail address: _______________________________________________________________

Number of persons in your household: ___ One ___ Two ____ Three or more

Children? ____ Yes ____ No. If yes, what are their ages?_____________________

Your Home

Do you rent or own? ____ Own ____ Rent

Does your lease/homeowners association restrict ownership of pets? ___Yes ___No

Is your yard fenced? ____ Yes ____ No

References

Please provide the names and telephone numbers of three references including your veterinarian and landlord (if
applicable.) Other references could include a friend, neighbor, employer, relative.

NameAddress Phone #

1.___________________ _____________________ _______________

2.___________________ _____________________ _______________

3.___________________ _____________________ _______________

Care and Responsibility

Are you prepared to make a commitment to care for this dog for the next 10-15 years?

____ Yes ____ No ____ Don't know

Are you prepared to commit to find a home where you can keep this dog if/when you move during the next 10-20
years? ____ Yes ____ No ____ Don't know

Are you financially prepared to deal with the cost of both routine (vaccinations, annual examination, dental
cleanings, heartworm treatment, etc.) and non-routine/emergency veterinary care of this dog?
____Yes___No___Don't know

Approximately how many hours a day will the dog be alone? __ 1-3 hrs __ 4-6 hrs __ Don't know

Where will the pet spend the day?___Loose in the house___Confined certain rooms

___ Confined to a room

Where will the dog sleep? ____________________________________________________

Who will have primary responsibility for the care of the dog?

May we call your vet for a reference?

Vet or Vet Clinic's name:_____________________________________________________

Address:___________________________________ Phone:________________________

Did you know that every rescue dog is spayed/neutered before adoption? Y/N

Did you know that the rescue dog must be on heartworm prevention? Y/N

Did you know that the rescue dog must havve an annual vet visit to include: Rabies, booster shots, examination and
heartworm test? Y/N

Describe your experience with Alaskan Malamutes:

What do you like least about Alaskan Malamutes?

Why do you wish to adopt an Alaskan Malamute? Companionship Obedience Sledding Therapy Agility

What sex do you prefer: ___ Male ___ Female ___ Doesn't matter

What age range? (If you must have a puppy less than 6 months of age, we recommend you contact a responsible
breeder)

___ Puppy (6-12 months) ___ Young adult (1-3 years) ___ Adult (4-7 years) ___ Senior (8+ yrs)

Misc:

What would you do if your dog got lost?

Where is the nearest animal shelter?

What will you do if the dog "marks" in the house?

Will you buy and use a crate?

History of Pet Ownership

What animals currently live in your household? ( Please list type of animal/reptile, sex, age, and how long you have
owned them)

Are these pets inside or outside? (Please explain)

What pets have you had in the past? (Please list type of animal, how long owned and what happened to the pet).

Which dog would you like to adopt and why?

All of the information that I have provided above is true and complete to the best of my knowledge. Should a dog be
placed with me, it will reside in my home as a pet. I agree to provide the dog with adequate food, water, shelter,
affection and medical care.

How would you like us to contact you? ___ via e-mail ___ call during the day ___ call during the evening

Signature of Applicant: ______________________ Date of application: ________

Thank you for taking the time to complete this application. Please mail this application to:

Shirley Thomas

Golden Years Alaskan Malamute Rescue

2430 Lorenson

Muskegon, MI 49445

If you have any questions regarding this application please feel free to call or e-mail:

231-766-2170

malamute49445@yahoo.com