ARWNY, Inc.

Our mission is to find new, loving homes for our rescues. All Akitas are altered,
vet checked and evaluated. This application is a required part of the adoption process
and will help to match the right Akita for your household. Please download the form into a
Word type program to complete and email to arwny@roadrunner.com or print a copy
which may be faxed to 716-741-2124 or mailed to the address below. With all the costs
involved with rescue, we do request a $300 ($350 if a puppy under 1 year) adoption donation to help defray our expenses
so that we may help more Akitas in need.
ARWNY is a 501(c)3 non profit organization and donations may be tax deductible.

Date: _____________________ ARWNY Rep: _____________ Orphan: _____________

Applicant: _______________________________________________________________________

Address: _______________________________________________________________________

City/State/Zip: _______________________________________________________________________

Home Phone: ___________________________ Work Phone: _____________________________

Email Address: ___________________________
If you have an email account it will be the primary means of initial communication - please check it regularly.

Have you contacted another rescue group? If yes, please list the group name, contact person and phone
number __________________________________________________________________________________

Describe the Akita you are looking for?_________________________________________________________

_________________________________________________________________________________________

Have you owned dogs before? Yes / No

How Many? ____ Any Akitas? Yes / No Any large dogs? Yes / No

What happened to them? ___________________________________________________________________

_________________________________________________________________________________________

Why do you want an Akita? _________________________________________________________________

When are you looking to adopt? Right away ___ In a few weeks ___ Over a month ___

Did you realize…

Akitas cannot ever be off leash in an open area (such as a park, street, unfenced yard)?	Yes / No
Akitas have a strong prey drive and can hurt small animals such as rabbits and cats?	Yes / No
Akitas should not be tied out in the yard?	Yes / No
Akitas are large and strong, stubborn and independent?	Yes / No
Akitas blow their coats twice a year?	Yes / No
Akitas blow their coats twice a year?	Yes / No
Akitas are naturally dominant and need to go to obedience training with the owner?	Yes / No
Akitas should not be tied out in the yard?	Yes / No
Akitas are large and strong, stubborn and independent?	Yes / No
Akitas blow their coats twice a year?	Yes / No
Akitas are naturally dominant and need to go to obedience training with the owner?	Yes / No
Akitas normally live to be 10-15 years old and need a commitment for that long?	Yes / No
Do you still think that an Akita is the right dog for you?	Yes / No

(We can help you pick another breed)

Home and Family

How long at address? _____ Own / Rent Plans to move: Yes / No When & Where: _____________

If renting, does lease permit large dogs? Yes / No Landlord Phone: _____________________________

Size of lot: __________ Fenced? Yes / No Fence Material: ________________Height: _____

Crate Available: Yes /No Kennel? Yes / No Are you willing to buy a kennel? Yes / No

Number of people in house: _____ Number of children (under 21): ____ Ages:______________________

Are children dog-trained? Yes / No

Anyone allergic to dogs? Yes / No

Anyone afraid of large dogs? Yes / No

How do the children react to dogs? _________________________________________________________

Will the Akita be in contact with other children? Yes / No Explain: _________________________

Other pets in house: Dogs _________ Cats _________ Birds _________Other _______________________

Potential problems with current pets: ________________________________________________________

Will the Akita be in contact with any other pets? Yes / No Explain: __________________________

Expected Routine

How much time will be spent with the Akita daily: Weekdays: _________ Weekends: __________

How many hours will the Akita be left alone daily: 0-2 Hrs___ 2-4 Hrs___ 4-8 Hrs___ 8-10 Hrs ___

Where will Akita be when you work?___________________ Where will Akita sleep? ______________

When will the Akita be outside? ___________________ Will the Akita be tied out? Yes / No

How often will the Akita be walked? _____ Where: _______ By Whom?_________________________

How often will the Akita be played with? _______________ By Whom?_________________________

How often will the Akita ride in the car? _____ Will the Akita be crated or restrained? Yes / No

Where will the dog be when you are away overnight? _________________________________________

Will you take the Akita to obedience training? Yes / No

Unusual circumstances the Akita will need to adapt to? ______________________________________

Other comments regarding daily routine: __________________________________________________

____________________________________________________________________________________

References

Employer Name: __________________________________ Phone:_____________________________

Address:_____________________________________________________________________________

City/State/Zip: ______________________________________________________________________

Years at Present Job: ______ Occupation: __________________

Current Veterinarian: _______________________________ Phone:___________________________

Local Animal Control_______________________________ Phone:___________________________

Current Trainer: ___________________________________ Phone:___________________________

Personal Reference: _______________________________ Phone:___________________________

Applicant Disclosure

Do you feel financially able to care for an Akita for its lifetime?	Yes / No
Do you feel physically able to care for an Akita for its lifetime?	Yes / No
Have the police been at your home for any disturbances?	Yes / No
Do you or anyone in you family have a history of animal, spousal or child abuse?	Yes / No

Please list any additional information regarding your home that has not been covered in this document:

________________________________________________________________________________________

_________________________________________________________________________________________

The information I have provided in this document is correct and true to the best of my knowledge and I have
not withheld any pertinent information. I understand that any misrepresentation of myself or my family or any
untruths in the information I have provided herein that are discovered at a later date will invalidate any
adoption agreement and will give ARWNY the right to reclaim the Akita without my permission and without
refund of any adoption donation.

_____________________________________________ ______________________
Signature Date

_____________________________________________ ______________________
Signature (spouse) Date

WHEN COMPLETED RETURN TO:
ARWNY, P.O. Box 428, E. Amherst, NY 14051

You should hear from us within 72 hours once we receive your application. If you have not heard from us by then please email us here to inquire about the status of your application.

Please Be Sure to check your "bulk mail folder" while waiting for us to reply as often times our responses mistakenly go into applicants' bulk folders and they delete without reading.