Rescue Rehome Adoption Application

First Name *

Surname *

Street Number and Name *

Suburb/Town *

State *

Select an option ACT NSW NT QLD SA TAS VIC WA

Postcode *

Email *

Phone *

Alternative Phone Number

Type of Residence *

Select an option Flat/Unit Standard Suburban Block Acreage (in Suburbia) Rural Property

Do you own or rent your home? *

Own your own home

Renting

Have you previously owned a Murray River Retriever? If yes, please supply detail *

Preferred age (tick all that suit you) *

Puppy

Young Dog

Older Dog

Preferred sex *

Male

Female

Either

Do you have children living in the house the puppy/dog is going to live in? *

Yes

No

If so, how many and their ages

Are there any other animals at the same property? *

Yes

No

If yes, which animals and how many?

Is there a particular dog you are interested in?

Please add any further information you think may be helpful

Consent *

I agree to MRRA keeping this application on its adoption list and contacting me when a dog that may suit my home needs one

To show you are a person, what is 5 plus 2?

Submit application