NorthEast Border Collie Rescue Adoption Application

Name
Title
Street Address
Address (cont.)
City
State/Province
Zip Code
Work Phone
Home Phone
Cell Phone
E-mail
How did you hear about Northeast Border Collie Rescue?
Please list the adults in your household, their relationship to you, their occupations and their ages:
Do they agree with your decision to get a dog?Yes No
If not, please explain:
Are there children in your household?Yes No
If yes, please list their ages:
Will they be responsible for caring for this dog? Yes No
Are there children in your neighborhood? Yes No
Are you frequently visited by children? Yes No
Do any children have access to your yard/kennel/house when you are not at home? Yes No
If yes, please explain how you intend to prevent them from teasing a dog, letting a dog out either intentionally or accidentally, or doing anything that might be detrimental to the welfare of a dog in your care.
Is anyone in your home allergic to animals? Yes No
Is anyone in your home afraid of dogs? Yes No
Is anyone in your home elderly or frail? Yes No

Your Neighborhood
Is your neighborhood: Rural Suburban Urban
Do you you live in a: Apartment Condo Mobile Home Single-family Home Military Housing
Do you Own or Rent your property?
If you rent, do you have permission from your landlord to have pets on the property? Yes No
Do you live in a development or other area where there are houses nearby? Yes No
Do you share a house with other families? Yes No
Are there neighbors nearby who would be upset by a barking dog? Yes No
Are they aware that you intend to adopt a dog? Yes No
Are there any restrictions to the number of dogs and /or cats or combination that you may have at your residence? Yes No
If yes, please explain:
How large is your property?
Do you own livestock? Yes No
If yes, please describe:
Do you have cats or other animals living in your house? Yes No
If yes, what kind and how many?
Is there a busy road nearby? Yes No
Do you have a fenced yard or outdoor kennel? Yes No
Please describe any fencing, including its height, and the size of the area it encloses:
Are you willing to allow one of our representatives to come to your house for a home visit and evaluation?

Yes No

Your Experience With Dogs
Why do you want to add a dog to your family at this time?
Why do you want to own a Border Collie?
Have you owned a dog before? Yes No
If yes, what breed, when and what happened to this dog:
Have you ever owned a Border Collie before? Yes No
If yes, when and what happened to this dog:
Briefly explain your understanding of the nature of a Border Collie, their special needs and how you will be able to meet those needs:
Your Current Dogs
Do you own a dog now? Yes No
If yes:
Breed
Spayed/Neutered? Yes No
If yes, at what age?
Sex
Age
How long have you owned this dog?
Please describe your dog's temperament, particularly with regards to other dogs:
Is your dog current on all vaccinations? Yes No
Has it been tested for Heartworm/Lyme disease? Yes No
Is it on any Heartworm Preventative? Yes No
Is it licensed in your town? Yes No
Have you ever adopted an animal from a shelter or rescue group? Yes No
If yes, please give the name and address of the rescue group:
Have you ever surrendered an animal to a shelter or rescue group? Yes No
If yes, please explain:
Have you ever been bitten or attacked by a dog? Yes No
If yes, please explain:
Are you comfortable approaching unfamiliar dogs? Yes No
If behavior problems arose in your dog, how would you deal with them?
Are you familiar with the animal regulations in your area? Yes No
Do you know the requirements for obtaining a dog license in your town? Yes No
Please list the names, phone numbers and /or email addresses, and their relationship to you and your dogs of three people who are knowledgeable about you and your care of dogs (i.e. trainer, kennel owner or groomer) Please include your vet as one of these references.

Your Preferences In A Dog
Age:
Gender:
Would you consider a dog that is five years old or older? Yes No
Would you consider a cross? Yes No
Would you consider more than one dog? Yes No
Do you want a dog for herding, search and rescue or other work? Yes No
If yes, please specify:
Do you want a dog for formal canine sport or competition? Yes No
If yes, please specify:
Are you looking for a companion dog? Yes No
Would you consider adopting a dog with physical problems like hip dysplasia or epilepsy if the disability maybe controlled or treated with medication or surgery? Yes No
Would you consider adopting a dog with an emotional problem such as separation anxiety, fear or aggression if it may be controlled or managed with training, behavior modification, and/or the use of medication?Yes No
After researching Border Collies, are there any traits in the breed that you would prefer to avoid?Yes No
If yes, please be specific and describe:
Is there a particular dog in NBCR that interests you? If so, which one and why do you feel this dog is a good match for you?
Are you contacting other sources in your search for a dog? Yes No
If yes, which one/s?
Are you willing to wait for the dog that is the best match for you and your lifestyle or do you want a dog NOW? Please explain.
How far are you willing to travel to meet a dog?

Your Lifestyle
Is there someone at home during the day on most days? Yes No
Approximately how many hours per day and on how many days will your dog be left alone?
Will the dog live in the house with the family? Yes No
If not, where will the dog be staying during the day and night?
If you are away during the day, where will the dog stay?
If you are away for an extended period of time (overnight or longer) where will the dog stay?
Will the dog be allowed to run loose at anytime? Yes No
Will you have your dog on a run, trolley or tied out at any time? Yes No
If yes, please explain when and for how long:
Are you planning to enroll your dog in obedience training classes? Yes No
If not, how will you train your dog? Please give a detailed description of your previous experience training dogs and the training methods you use.
How much are you willing to spend on vet care for your dog each year?
What do you consider normal vet care for a dog?
How do you intend to adequately exercise your dog, both mentally and physically?
Please add any information about yourself that you think would be useful in helping us select the right dog for you:
I attest to the truthfulness of my answers. I understand that falsification or fabrication of any answers will be reason for NBCR to reject my application to adopt a Border Collie through NBCR. I understand that NBCR has the right to refuse any applicant.
Signed:
Date: