Golden Years Alaskan Malamute Rescue, Inc.

Owner placement assistance program.

Available for Michigan Residents only

Golden Years Alaskan Malamute Rescue, Inc. frequently finds itself filled to capacity on a regular
basis, which limits our ability to take Alaskan Malamutes that are turned in by their owners. We do
assist owners for a small fee, in helping them place their dog by posting a few pictures, a description
of the dog's personality and a contact phone number or e-mail address for the owner on our website
until the dog is placed.

If you would like to take advantage of this service, please fill out this form completely and include a
check for $25.00 made payable to Golden Years Alaskan Malamute Rescue. Please include a few
good photos of the Malamute showing it's full face, a full body shot and a shot of the dog having fun,
showing off it's personality.

Owners name: _____________________________________________________________

Address: _____________________________________________________________

City,State,Zip: _____________________________________________________________

Phone number: ______________________ E-mail ______________________________

Dog's name: __________________ Age: ______________ Male/Female: ___________

Spayed/neutered? _____________

Good with cats? Y N Good with children? Y N Good with other dogs? Y N

Housebroken? Y N Crate trained? Y N Obedience training? Y N

Reason for placing the dog: __________________________________________________

___________________________________________________________________________

Personality: positive ________________________________________________________

__________________________________________________________________________

Negative: __________________________________________________________________

__________________________________________________________________________

Any other comments: _______________________________________________________

__________________________________________________________________________

I, _______________________________________ agree to let Golden Years Alaskan Malamute
Rescue post information about my Alaskan Malamute. I understand that Golden Years Alaskan
Malamute Rescue is not responsible for placing my Malamute, nor are they obligated or required to
take my dog into the rescue. Golden Years AMR assumes no legal liability in the placement of the
dog. I will notify Golden Years Alaskan Malamute Rescue if my dog is placed, and I understand that
the $25.00 is a flat, non refundable fee for this service. I authorize Golden Years to post my contact
information so potential adopters can contact me directly via phone or e-mail.

Signed: _________________________________ Date: _____________________

Owner

Agreed: _________________________________ Date: _____________________

Golden Years Alaskan Malamute Rescue

Photos will be returned upon request at no extra charge. You will be contacted by Carol Januszewski
once your dog is posted to the site. She may need to contact you for further information prior to
posting the web site.

Mail the signed form and check to: Golden Years Alaskan Malamute Rescue

C/O Carol Januszewski

545 Eastern Ave NE

Grand Rapids, MI 49503-1808