* Denotes required field
*Home Phone: (
Work Phone: (
Cell Phone: (
*Do you live in:
House Condo Apartment Farm Other
Own or Rent your home?
If you rent, do you have your landlord's permission to keep a dog?
Are there restrictions?
If there are restrictions, please explain below
*The dog will be kept primarily:
Please describe the outdoor area where the dog will spend time
(size, height, and type of fencing; shelter; etc.)
*Do you have children under the age of 18 or are there often children visiting?
*Do all family members work?
*Please list occupations:
*Approximately how many hours a day will the dog be left alone?
*Where will the dog be during the day?
*Where will the dog be during the night?
*Are you willing to crate your adopted dog?
Please list other pets in the home:
*Have you had pets before?
If so, where are they now or what happened to them?
*What qualities of the breed made you decide to apply to adopt a Border Collie?
*Given that this is a highly work-oriented breed that does not do well when bored or
under-stimulated, what plans do you have for the dog you adopt? (Walks, Frisbee, obedience,
agility, stock work, etc.)
*Many Border Collies are extremely noise-sensitive. Would this suit your lifestyle?
*Is there a particular dog you are interested in?
Yes No Name:
Do you have an image of the kind of Border Collie you would like to adopt?
(Rough coat, smooth coat, color preference, etc.)
*Do you have an upper age limitation?
Yes No Age limit:
*Would you consider a Border Collie mix?
*After researching the breed, are there any characteristics you would prefer to avoid in
an adopted Border Collie? (remember that almost all Border Collies that come through
our program have either been neglected or abandoned, and have an unknown history).
*Are you prepared to pay an adoption fee? (Our current adoption fees range from $125 to $150.
Rescue dogs are spayed/neutered, vaccinated, checked for heartworms and intestinal parasites and treated
if necessary, on heartworm preventative, treated with flea/tick preventive, and microchipped).
Please provide the names, telephone numbers, and/or email addresses of two personal references
(who are not relatives)
*Contact Info. (email or phone)
Please provide the name, address, and telephone number of your current veterinarian:
Please add any information about yourself that you think would be useful in helping us select
the right dog for you.