First name:                     

Last Name:                     

Address line 1:               

Address line 2:               

City:                               

State:                             

Zip Code:                       

Home Phone#:               

Work Phone #:               

Best time to call:             

Email address:               

Family Data:

Spouse/Significant other ?                   

Does spouse/significant other  approve of getting this dog? 

Your Age?                                

Children's ages (if applicable)    

Occupation of adults in family: 

        Applicant                        

        Spouse/Significant other   

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 "dealbreaker" and would not allow you to keep a dog

Have you ever owned a Malamute before?      

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?:         

Do you have a fenced yard?  Type/Size?                  

Previously owned dogs:       

Where are they now?

Dogs present at home now, and vet status - are they spayed/neutered?:

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?                 

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

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.