Pine Hills USA Border Collie Rescue
ADOPTION FORM
This form is required to start the process of border collie adoption. Your
information will be kept
strictly private. Please fill out this form as completely as possible. The more information
that you
can provide us, the better we can match your needs with the right border collie.
Please check all
boxes that apply where appropriate. Also, don't forget to check
the listings of available border
collies to see if any of them would be an appropriate match.
Filling out this form does not constitute the filing of an official adoption
agreement for Border
Collie Rescue. A signed version of the
Border Collie Adoption Contract
must also be mailed to
the address indicated below.
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 on separate sheet):
Name:________________________________________
Address:______________________________________
_____________________________________________
_____________________________________________
Phone#:________________________________________
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? _______________
Are there any restrictions to the number/size of animals you may have in home?____
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):________
Border Collie Environment
Where do you intend to primarily keep the border collie?_(indoors, outdoors, etc)
____________________________________________________________________
Do you have a fenced-in yard for the border collie?_______________________________
Height of fence in 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?__________________
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?____________
Are you willing to pay a rescue fee?__________
If 'No', please explain:___________________________________________________
Are you willing to pay for other special costs, such as shipping, medical
expenses,
crates, etc.?______
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: (M, F, Doesn't Matter)________________
Maturity: (Puppy, Adult, Senior, Doesn't Matter) _____________________
Color:
____Red and White
____Black and White
____Tri-colored (Black/White/Red)
____Mostly Black
____Mostly White
____Blue Merle
____Doesn't Matter
Would you be willing to accept another color?______________________
__________________________ ________________________ _________________
Typed or Printed Full Name
Signature of Applicant
Date
Please mail to:
Pine Hills USA Border Collie Rescue
735 County Rd 37
Fitzpatrick, AL 36029
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