First name:

Last name:

Last Name is required

Address line1:

Address line2:

City:

State:

Zip code:

Phone#:

Work Phone#:

Best time to call:

Email address:

Family Information:

Your Age?:

Marital status

Spouse/Significant other:

Does spouse/significant other  approve of getting this dog:

Yes No

Children's ages (if applicable):

Applicant occupation:

Spouse/Significant other occupation:

Do you own or rent?

Others in household who will have contact with the dog?

General information concerning the type of dog you are interested in:

Why are you interested in obtaining one of our Alaskan Malamutes?

What qualities do you like in the Malamute?

Please be specific about type of personality you prefer

What don't you want to find in a Malamute? List ANY qualities that would be a "deal breaker" and would not allow you to keep a dog

Have you ever applied with any other shelters/rescues and what was the result?

Have you ever owned a Malamute before?

Yes No

Where will the dog stay during the day?

Where will the dog stay during the Night?

Acceptable age range:

Do you have a gender preference?

No Preference   Female   Male

Do you have a fenced yard?  Type/height?

What brand of dog food do you feed?

What would you do if your dog bit someone?

How would you handle an unexpected emergency vet bill for several thousand dollars?

Please list any previous dogs owned, indicate those that were owned as family dogs, and those you obtained on your own as an adult:

Where are they now?

Dogs present at home now, and vet status
Are they spayed/neutered?

What type of heartworm preventative do you use/do you give it year round?

How long will the dog be left home alone on average and when left alone where will it be?

Other pets currently owned:

Name address, phone number of your veterinarian, and one additional reference:

Would you be willing to obedience train a dog that you received from IAMRA if it was recommended or required as being in the best interests of the dog and you?

Yes   No

Would you be willing to allow a rescue member to visit your home by appointment?

Yes   No

How did you hear about the Illinois Alaskan Malamute Rescue Association?

Please add any other information you wish us to consider in placing one of our Malamutes with you.  We would appreciate it if you would give us some insight into the expectations you may have for this addition to your family. Please be as specific as possible.

Please note: To submit an application, you must enter a First name, Last name and a phone number or email address

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