General Information

Name:

Address:

Email:

Phone: - -

Please list other household members and their ages:

How did you hear about us?

Daily work hours:

Daily time with dog(s):

What daily work or activities will your Border Collie have?

Do you own or rent your home? Own Rent

Is you home: Urban Suburban Rural

How many acres/or approximate size of yard:

Is your yard fenced?

Type of fencing:

Fence height:

Where will your Border Collie stay during the day?

Where will your Border Collie stay during the night?

Do you plan to keep your dog primarily: Indoors Outdoors

Are there other animals in your household? If so, please list type, sex and age of each:

What happened to your last dog?

Please list any type of livestock living on or near your property:

Do you prefer the dog to be: Male Female

Why?

Color Preference: Doesn’t matter

Age Preference: Doesn’t matter:

Where will the dog be during working hours?

How much money will you be willing to spend for vet care each year?

Are you willing to allow a home visit by appointment: Yes No

Please tell us why you want a Border Collie:

Please list the daily activities that you will provide your Border Collie with:

Do you plan to take your dog to a obedience class? Yes No

How long each day/week do you plan to spend exercising your dog?

How long each day/week do you plan to spend training your dog?

References — Please supply us with 2 or more references, not living with your or a relative.  We suggest: your veterinarian, a friend, a dog trainer.

Reference 1:
Name:

Address:

Phone #: - -

Relationship:

How many years have you known this person?

Reference 2:
Name:

Address:

Phone #: - -

Relationship:

How many years have you known this person?

Reference 3:
Name:

Address:

Phone #: - -

Relationship:

How many years have you known this person?

Veterinarian:
Clinic:

Address:

Vet’s Name:

Phone: - -

By signing this form, I am attesting to the truthfulness of my answers. I understand that the falsification of any of the above information will be grounds to disallow the adoption of a rescue Border Collie.

Signature:

Date:

SCBCR reserves the right to refuse any applicant