Pine Hills USA Border Collie Rescue
ADOPTION FORM

Contact Information

Your Name:

Your Address:

Phone# (Home):                   Phone# (Work):
    

Email address:

Best Time to Contact You:

Veterinarian Information

Veterinarian (if more than one, list all):

Family Information

Household Members:
     Number Adults: Number Children:
Age Youngest Child: Age Oldest Child:

Home Information

Where Do You Live? City Apartment City House Rural Apartment Rural House Country/Farm Home Other

Do You Rent or Own? Own Rent/Lease

If you rent, do you have the landlord's permission to keep a dog? Yes No

Are there any restrictions to the number/size of animals you may have in home? Yes No

Other Pets/Animals

Do you have any other animals (Check all that apply)?

Pets: Cats: Dogs: Other:

Farm: Horses: Cows: Sheep: Goats: Other:

If you have horses, will the border collie have access to them?
(not recommended): Yes No

Border Collie Environment

Where do you intend to primarily keep the border collie? Indoors Outdoors

Do you have a fenced-in yard for the border collie? Yes No Height of fence :   inches

Type of fencing: Chain Link Field Fence Picket Fence Wooden Fence Other If 'Other', explain:

Other Important Information

Have you ever owned a border collie before? Yes No

Why do you want a border collie rather than another breed?

For what purpose do you want a border collie? Herding/Work Agility Obedience Playing/Frisbee Companionship Other
If 'Other', explain:

Do you have any any experience caring for a border collie?

Do you have any any experience caring for other types of dogs?

Have you ever turned an animal over to the Humane Society or Shelter? (Explain)

Have you ever adopted an animal from the Humane Society or Shelter? (Explain)

What happened to the animal? (Explain)

Would you be willing to have a rescue representative visit you in your home?

Is someone home during the day? Yes No

Are you willing to pay a rescue fee? Yes No
If 'No', please explain:

Border Collie Preferences

Animal you are applying for:

Name of Border Collie:

Rescue/Shelter Animal Number:

Rescue/Shelter where located:

If a specific border collie is not available, we will keep your application on file. What kind of border collie are you looking for?

Sex:        Female Male Doesn't Matter
Maturity: Puppy Adult Senior Doesn't Matter
Color:     Red and white Black and white Tri-colored (Black/white/red) Doesn't matter Mostly black Mostly white Blue merle Other

Would you be willing to accept another color? Yes No

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