EmailMe Form - ADOPTION APPLICATION - Tri-County Collie Rescue

Your Name

First Last

Spouse/Partner

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email

PHONE 1

### - ### - ####

PHONE 2

### - ### - ####

If you presently have children living with you, please list their names and ages:

Any other people living in the home besides children? If so, please list and indicate relationship to you:

Does anyone living in the home:

have allergies to animals?

Have asthma?

If you are renting your home, name and phone of owner/landlord:

Please describe your home (i.e. house, mobile home, apartment, etc.)

If you have lived here for less than two years, please list previous address.

Describe your neighborhood:

City

Suburb

Country/Rural

Describe your Yard:

Does that door that you will use to let the dog outside open directly into a fenced area?

Yes

No

Does your home have a "doggy door"?

Yes

No

If your answer is yes, when is the doggy door available to be used?

We do not have fencing, we have a chain and dog house for the dog to use.

Yes

No

If none of the above, please explain how and where you will allow the dog to exercise and relieve itself?

Do you have other pets at this time?

Yes

No

If yes, are all pets spayed or neutered?

Yes

No

Do you believe in using heartworm preventative?

Yes

No

Please list other pet(s), their species, name(s) and age(s) and whether they are indoor or outdoor pets.

If you owned pets in the past and do not currently, what happened to them?

What role would you like your new dog to play in your life?

Please indicate where your dog would stay when you are not at home:

Please indicate where your dog would stay while you are at work:

Please indicate where your dog will sleep:

How many hours per day will the dog be alone?

Crate:

Have a crate and plan to use it

Do not have, plan to buy

Do not plan to use a crate

If you do plan to use a crate, how many hours per day will the dog be crated?

If you do not plan to use a crate, please explain why.

What kinds of solutions would you be willing to try if housebreaking accidents occurred?

What kinds of solutions would you be willing to try if the dog was too "busy" or "hyper"?

In terms of brushing, I am:

Up to a lot of brushing

Up to a little brushing

Going to use a professional groomer

REFERENCES:

PLEASE LIST VETERINARIANS YOU HAVE USED

Veterinarian-1 Phone number

### - ### - ####

Veterinarian-2 Phone number

### - ### - ####

REFERENCES:

PLEASE LIST TWO PERSONAL REFERENCES and PHONE NUMBERS

REFERENCES:

PLEASE LIST ANY GROOMER OR TRAINER YOU HAVE USED and PHONE NUMBERS

I am interested in the following dog(s):

I/we are not interested in any dogs listed, but please put us on the list for a dog that meets the following criteria:

Please include any other information you would like to provide to help us make a match between you and your new dog:

I CERTIFY THAT:

(you must check all three statements) *

(1) I understand this application is only an interviewing tool, and my submission does not guarantee the placement or availability of a dog to my family.

(2) I understand that that applications will not be returned.

(3) I understand that incomplete applications will not be processed.