E-mail Address: *
Name, First & Last *
Age *
Spouse/Partner
Age
Address *
City *
State *
ZIP *
Home Phone
Secondary Phone
Best time to contact you
Best place to contact you
Employer
Phone
Spouse/Partner Employer
Phone
Does either job require frequent travel out of town?
Are you/spouse subject to relocation?
Are you a student?
If yes, anticipated graduation date:
Are you in the military?
If yes, anticipated date of discharge:
Are you expecting a child or planning a family?
How many children are living at home:
Child Name/Age
Child Name/Age
Child Name/Age
Child Name/Age
Child Name/Age
Child Name/Age
Other Person/Relationship
Other Person/Relationship
Is anyone allergic to animals?
Does anyone have asthma?
Do you own or rent your home?
If renter, exact name of owner:
If renter, phone number of landlord:
Dwelling type
If other, please describe
How long have you lived at this address?
If less than 2 years, provide previous address:
Describe your neighborhood:
Does your home have a yard?
Is the yard completely fenced?
Do you also have a pen in the fenced yard?
Describe fencing:
How tall is the fencing?
Is the gate locked with a padlock?
Does the door that you will use to let the dog outside open directly into a fenced area?
Can strangers gain access to the yard from the street?
If you do not currently have fencing, are you willing to install fencing?
If yes, what type of fencing?
By date?
We do not have fencing, we use a chain and dog house to keep the dog in the yard.
If none of the above, explain how and where you will allow the dog to exercise and relieve itself?
Do you have other pets at this time?
If yes, are ALL pets spayed or neutered?
Do you believe in using heartworm preventative?
Other pets are
Other pets are
Pet 1 Type/Name/Age
Pet 3 Type/Name/Age
Pet 4 Type/Name/Age
Pet 2 Type/Name/Age
If you owned pets in the past and do not currently, what happened to them?
What role would you like your new collie to play in your life?
If other, please describe
Where does/would your dog stay when you are not at home?
Where does/would your dog stay when you are away at work or running errands?
Where does/would the dog sleep at night?
How many hours per day will the dog be alone?
Do you have a crate?
Do you plan to use a crate?
If no, please explain why
How many hours per day will the dog be crated?
What kinds of solutions would you be willing to try if housebreaking accidents occur?
If other, please describe
What kinds of solutions would you be willing to try if the collie was too busy or hyper?
If other, please describe
In terms of brushing, I am
Veterinarian Name/Address/Phone
Previous Veterinarian Name/Address/Phone
Groomer Name/Address/Phone
Trainer Name/Address/Phone
Personal Reference 1 Name/Address/Phone
Personal Reference 2 Name/Address/Phone
I am interested in the following collies from the website:
Please e-mail a copy of my application to the foster homes of the collies I am interested in.
I/we prefer to be contacted by
I/we are not currently interested in any of the dogs currently listed, please put us on the list for a dog that meets the following criteria: (age, sex, coat color, coat type)
Reasons for specifying the above, if any:
Any other information you would like to provide to help us make a match between you and your new collie:
I certify that
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