Thank you for taking the time to complete this form. After we receive your application, we will contact you shortly.
Please, make sure that you have read the "Adoption guidelines" before submitting this form. 

Tell us about yourself
Please fill out ALL fields.  If necessary, enter N/A

First and Last Name:
Address:
City:
State:
  Zip:
Home phone
Work phone
Name of the dog you're interested in : (if applicable)

Tell us about your home
Please fill out ALL fields.  If necessary, enter N/A

1.  How many people in your home (ie..Mom-Dad-2 kids)?:
2.  Do you have children living in your home (even part-time)?:   Yes No
3.  Please list ages of children:
4.  Do all adults in the house work?:

4.  Ages of residents:

4.  Place of Employment:

5.  Is anyone home during the day?  If so, who and what hours?:
6.  Do you live in a : House, Condo, Apartment or other?:
7.  Do you own or rent?:  Own Rent
8.  If renting, what is the name and phone number of your Landlord?:
9.  Do you have a fenced yard?: Yes No
     If not, how will the dog be excercised?:


Tell us more about you
Please fill out ALL fields.  If necessary, enter N/A
10.  Have you placed an application with any other Rescue group?: Yes No
       If yes, who?:

11.  Do you currently have any other animals?: Yes No
       If yes, please list: type, age & sex and if they are spayed/neutered:

12.  Are (or were) your pets current on Hearworm prevention? (required):
Yes No
       What type of Heartworm prevention do/did you use?:

13.  What type/brand of dog food do you intend to use?:

14.  How many pets have you owned in the last 10 years?:
       What happened to each of them?:

15.    Do you currently have a Veterinarian?: Yes No
         Name of Vet:    Vet Phone #:

About Dogs
Please fill out ALL fields.  If necessary, enter N/A

16.  Have you ever owned a Collie before?: Yes No
17.  Why do you want a Collie?:
18.  Are you aware that Collies are "barkers"?:
19.  Are you aware of all a Collies needs? (i.e. grooming, exercise):
20.  Are you aware that Collies may be shy around new people, and may take awhile to bond with?:
21.  What role will this animal have? (ie.. pet, watchdog, breeding):
22.  Do you intend to keep this dog primarily indoors or outdoors?:
23.  Where will this dog stay during the day, while you are at work:
24.  Where will the dog sleep?:

25.  Do you have the time and or patience to housetrain a dog?:
26.  Would you be willing to take a "special needs" (blind, deaf, sick) dog?:
27.  Would you be willing to work with a "behavior problem" dog?:
28.  Would you be willing to take a much older, more needy dog?:
29.  Do you have a color preference?:
30.  Do you have a sex preference?:
31.  Do you have an age preference?:
32.  Do you have a size preference?:
33.  Are you aware of the financial responsibilities of dog ownership (including vet care, medications, food, licensing, shots, grooming, etc.) and that total expenses of owning this dog could be $1,500 per year?:
34.  Would this dog be a priority in your life?:
35.  What circumstances, in your opinion, would justify you getting rid of this dog?:
36.  Are you aware of the fees that our rescue organization charges?
37.  Are you willing to have a member of Collie Rescue visit your home prior to adoption and after the adoption?:
38.  Would you be willing to take this Collie to Dog Obedience School?:
Yes No
Anything else you would like us to know when considering your application:

VERIFICATION
(required)
    
Name Of Closest Relative not living with you: Relationship:
 
     Relative's Address:
City:   State:   Zip:
     Telephone of Relative:


       Your Email Address:
Confirm Email:

All of the answers I have given, are true and correct to the best of my knowledge. Adoption guidelines.
                         Signature of applicant:
Date:

It may take several seconds to process your application.  
Please be patient and do not press the Submit button more than once.

Thank you for your interest in Collie Rescue!