| First name: * |
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| Last name: * |
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| Co-applicant's first name: |
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| Co-applicant's last name: |
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| Address: * |
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| City: * |
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| State: * |
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| County: * |
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| ZIP Code: * |
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| Email address * |
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| Home phone # * |
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| Work phone # |
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| Cell phone # |
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| Where did you hear about Collie Rescue? |
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| Have you had a collie before? |
Yes
No
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| Have you had a dog before? |
Yes
No
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| What breed? |
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| Why have you chosen a collie? |
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| What is your main interest in adopting a collie? |
Companion
Guard dog
Obedience
Gift
Breeding
Playmate (for other pet)
For someone other than yourself
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| Do you have a color preference? |
Sable and white
Tri-color (black)
Blue merle
White
No preference
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| Do you have a preference for the sex of the dog? |
Male
Female
No preference
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| What age collie are you interested in? |
Younger than 1 year
Young adult 1 - 5 years
Adult 5 - 8 years
Senior, more than 8 years
No preference
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| Is there a particular collie you are interested in? Why? |
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| Do you have one or more other dogs already? |
Yes
No
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| For each, please tell us his age, sex, and if he is altered. |
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| Do you have one or more cats? |
Yes
No
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| For each, please tell us his age, sex, and if he is altered. |
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| Please list the type, sex, and age of any other pets you have. |
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| Do you live in a ... |
House
Townhouse
Apartment
Condominium
Mobile home
Other (please list in comments)
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| Does your residence have inside stairs the dog would have to navigate regularly? |
Yes
No
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| Does your residence have stairs the dog would have to navigate to get in and out of the house? |
Yes
No
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| Do you own or rent? |
Own
Rent
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| If you rent, are you allowed pets? |
Yes
No
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| What is your landlord's name and phone number? |
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| Is there a weight limit? |
Yes
No
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| If yes, what is it? |
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| Is there a limit on the number of pets? |
Yes
No
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| If yes, what is it? |
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| How long have you been at this address? |
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| How many adults are in the household? |
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| Do you have children? What are their ages? |
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| Do you have a fully enclosed fenced-in yard or dog run? |
Yes
No
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| If so, please describe the enclosure (type, height, all four sides, etc.) |
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| If not, would you be willing to install a fence or dog run? |
Yes
No
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| If not, how will you exercise your Collie and allow him to eliminate? |
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| Where will the Collie be primarily kept? |
Indoors
Outdoors
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| Will the collie be left outdoors unattended for long periods of time? |
Yes
No
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| Will the collie be left outdoors when you are gone from the house? |
Yes
No
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| Will the collie be left on a tieout or trolley unattended? |
Yes
No
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| Please explain why if you have answered yes to any of the preceding questions. |
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| Do you have a good place for the Collie to stay when you are gone overnight or on vacation? |
Yes
No
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| Approximately how many hours will the Collie be left alone per day? |
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| How many days per week? |
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| Is someone home during the day? |
Yes
No
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| Where will the Collie be kept during the day? |
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| During the night? |
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| Are you familiar with the needs of the collie breed? |
Yes
No
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| How much grooming do you think a Collie needs? |
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| How much excercise do you think a collie needs? |
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| Who will be responsible for the Collie's upkeep? |
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| Grooming? |
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| Feeding? |
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| Vet visits? |
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| Exercise? |
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| Are you interested in taking obedience classes? |
Yes
No
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| Why? |
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| Are you prepared to assume the financial responsibilities of caring for an animal including inoculations, other veterinary care, good quality food, licensing, etc? |
Yes
No
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| Are you familiar with the pet responsibility laws in your area? |
Yes
No
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| Is anyone in your household allergic to animals? |
Yes
No
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| How severely? |
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| ALL animals need some time to adjust to their new surrounding; especially when other animals are involved. Are you prepared to devote extra time and/or training in the beginning? |
Yes
No
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| Until your pet is trained, the Collie may urinate or defecate in your home, and may chew household items. Are you willing to accept this? |
Yes
No
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| If you are having housebreaking, or behavior problems with the Collie, would you consider obedience training and/or crate training? |
Yes
No
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| When you need to discipline the Collie, how would you do it? |
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| What circumstances, in your mind, justifies getting rid of a dog? |
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| When are you interested in getting a Collie? |
Immediately.
When the right dog is available.
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| Do you want ... |
us to contact you when a dog is available?
to contact us when you see a dog you are interested in?
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| If a dog is not available right away, do you wish to be added to our waiting list? |
Yes
No
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| Please add any comments that may help us in our decision. |
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