Please fill out the application completely.

Personal Information

Date:

Your full name:

Spouse's full name:

Your age:

Address:

City, State, Zip:

Phone (H):

Phone(W or cell):

E-mail Address:

When do you check your e-mail? Select Daily Weekly Monthly

Occupation

Years there?

Including commuting time, how many hours per day will the dog be alone?

Spouse's occupation?

Years there?

Daily hobbies and activities:

Does anyone in your family have pet allergies? Select No Yes

Please list the names and ages of all people residing in your household:

The Dog You Are Interested In:

Do you prefer: Select Female Male No Preference

Color preference: Select Black & White Tri Color Merle Red Other No Preference

Are are you interested in a particular dog (give name)?

Please tell us a little about yourself, why you want this dog, and why you want a Border Collie:

Would you consider a special needs dog? Select Yes No

Age preference (check all that apply): less than 1 year    1-3 years    4-7 years    8 years and older    doesn't matter

How much do you expect to spend each year on veterinary care?

How much do you expect to spend each month on food, grooming, etc?

Are you looking at adopting a dog from some place else? Select Yes No

If yes Where?

If yes Why?

Your home and yard

Do you live in: Select House Apartment Condo Other   Other:

Approximate size of yard?

Do you rent? Select Yes No

If you rent, does your rental agreement permit pets? Select Yes No

Does your rental agreement have a size limit on a dog? Select Yes No

If yes how many lbs?

Landlord's name, address, and phone number (required)

How long have you lived there?
YearsMonths

What type of area do you live in? Select City Suburb Rural

Are there any ordinances limiting the number of dogs you can have on your property?
No Yes If Yes how many?

Is your property fenced? Select Yes No Type/height of fence?

If not fenced, how, when, and where will your dog be exercised?

Where will the dog spend its time alone (Please be specific)?

Where will the dog sleep at night (Please be specific)?

Care and Training of the Dog

Would your dog be living with or have any of these neighbors/visitors, or encounter any of these situations/activities regularly? (Check all that apply)

Who will provide the majority of care for this pet?

What activities or work will your Border Collie have?

Have you ever participated in an obedience class? Select Yes No

Do you plan to enroll the new dog in an obedience class? Select Yes No

How do you feel about using dog crates?

When you go on vacation, where will your dog go and who will care for it?

If you move, what will you do with your dog?

Once your dog arrives, how long do you feel he/she needs for an adjustment period?

What behaviors would you have a hard time dealing with in a dog you adopt? (check all that apply)

Your Other Animals:

Please list all other animals you have owned in the last ten years (living or deceased):

If you do not currently have a dog, how long since you had one?

If you do not currently use a vet, please provide previous vet's name and number (if applicable).

Other Information

How did you hear about us?

Have you ever applied to adopt a dog from us? Select Yes No If so, when and which dog?

What conditions or circumstances would cause you to give up a dog?

Are you aware that if you adopt a dog from MWBCR, you are required to return the dog to us if you can no longer keep it: Select Yes No

Please answer the following questions briefly:

What is heartworm?

How can it be prevented?

How often should your dog have booster vaccinations?

How often should your dog be checked for internal parasites?

References

Please list four (4) people who have known you for at least 2 years. We recommend your vet, dog trainer, neighbor, personal friend, co-worker. Please do not list family members as references. Please give home numbers only.

1.Name of Vet:

Phone Number:

Address:

2.Name:

Relationship to you:

Phone Number:

Address:

E-mail Address:

When do they check their e-mail? Select Daily Weekly Monthly

3. Name:

Relationship to you:

Phone Number:

Address:

E-mail Address:

When do they check their e-mail? Select Daily Weekly Monthly

4.Name:

Relationship to you:

Phone Number:

Address:

E-mail Address:

When do they check their e-mail? Select Daily Weekly Monthly

I hereby affirm that all of the above information is true and correct. I understand that submission of this application does not necessarily mean that I will be approved to adopt and that you reserve the right to reject any applicant. I authorize you to verify any and all information set forth in this application and to contact my personal references.
Without your initials and $10 application fee (payable on the confirmation page which you will be taken to once you click the submit button), we cannot process your application.

Initials Date