Name    

Email address

Address

City    County  State  Zip 

Home Phone Work Phone Mobile Phone

Are you over 21?  yes no

When is the best time to call?   Work hours

Number of adults in household

Names and ages of all adults and relationship to you:

Number of children and ages (please include children that do not live with you but visit frequently, ie: stepchildren or grandchildren)

Which dog or dogs are you interested in adopting and why?

If the dog(s) you are interested in is/are not available. would you be interested in a BC of another  sex  color  size age ? (check all that apply)

Do you live in a House Condo/Townhome Apartment Military Housing Mobile Home Other  If other, please specify

Do you have a completely fenced yard? fully fenced  partially fenced  no fencing not now but planning to build N/A - no yard

Type of fence:  Wood (stockade) Wrought Iron Chain Link Invisible/electric Wire or pipe Combination of types Other If other, please specify 

Fence Height: Yard Size:

How long have you been at your current address?

Do you have a pool/spa  pet door? (check all that apply)

Do you own or rent/lease ?

If you rent/lease, does your landlord allow pets? yes no    Is a pet deposit required?yes no 

Size/weight limit? yesno   Size limit:

Name of Apartment Complex or Landlord 

Phone Number of Apt Complex/Landlord

Does anyone in the household have allergies or asthma that could be aggravated by the addition of a dog? yes no

Have you applied with any other rescue groups or shelters?yesno

 If yes, please list, name of shelter/group, date and outcome:

Who will be the primary caretaker of the pet?

The pet will be kept: mostly inside mostly outside partially inside partially outside

On a work day (or a typical day if you do not work outside the home), how many hours a day will the pet be home alone?

Where will your dog stay when you are not home? (check all the apply) In house, crated In house, not crated Outside, kennel/dog run Fenced yard On chain/rope Garage Patio Other

If other, please explain

Why do you want to adopt this dog? (check all that apply) companion for child  companion for self  companion for other pet  protection  gift  house pet working/herding  agility training/competition competitive flyball training  freestyle frisbee training/competition exercise partner other

 If other, please explain:

Under what circumstances would you give up an animal? (check all that apply) excessive veterinary expensephysical characteristics of pet (too much fur, etc) barking  moving too energetic/hyper jumps on people financial difficulties family health problems digging housetraining problems  not enough time for pet aggression towards an animal  chewing destructive in yard/home  fence jumper/gets out of yard  never other

If other please explain:       

Have you ever given or sold a pet to any other person or a shelter? yes  no

Have you ever rescued an animal or adopted a rescue animal?  yes  no

Do you have livestock (chickens, horses, cows, sheep etc.)? yes  no   

If yes, please specify:

Are you willing to participate in obedience training if recommended? yes no

Are you willing to buy and use a crate if recommended? yes no

Are all your dogs on heartworm preventative?yesnono dogs 

 What brand and how often do you give the preventative?

Veterinarian's name and/or animal clinic

Vet's address

Vet's phone number

Please list all pets now owned or owned within the last 5 years:

1. Dog  Cat  Other   Breed:

     Sex: Male Female  Age:  Length of Ownership:

     Do you own the pet now? yes  no   If no, what happened to him/her?

2. Dog  Cat  Other   Breed:

     Sex: Male Female  Age:  Length of Ownership:

     Do you own the pet now? yes  no   If no, what happened to him/her?

3. Dog  Cat  Other   Breed:

     Sex: Male Female  Age:  Length of Ownership:

     Do you own the pet now? yes  no   If no, what happened to him/her?

4. Dog  Cat  Other   Breed:

     Sex: Male Female  Age:  Length of Ownership:

     Do you own the pet now? yes  no   If no, what happened to him/her?

5. Dog  Cat  Other   Breed:

     Sex: Male Female  Age:  Length of Ownership:

     Do you own the pet now? yes  no   If no, what happened to him/her?

Have you ever owned a Border Collie or a dog from the Herding group (Sheltie, Collie, Aussie, etc.)? yes  no

Do you still have that dog? yes  no    If no, what happened?

What are the qualities you liked most about that dog?

What are the qualities you like least about that dog?

Is there anything else you would like us to know?

Have you ever volunteered for a shelter or rescue organization?  yes  no

I am willing to pay an adoption donation. (Adult companion dog donation is $200) yes  no

If applicable, please obtain a copy of your rental agreement that states you may have a dog.  Our volunteer will ask for it when your home visit is scheduled. This is a requirement for adoption and the adoption will be denied without the rental agreement.

I am in full agreement with the Border Collie Rescue Texas, Inc. Terms of Adoption and understand that if I ever relinquish the dog that said dog must be returned to Sam Ford of Border Collie Rescue Texas, Inc. or his designated representative.  By submitting this application I am attesting to the truthfulness of my answers.  I understand that falsification of any information given to Border Collie Rescue in this application or in any other medium will be grounds to disallow the adoption of a rescue Border Collie.  I understand that a vet reference and a home visit are required for adoption.   I understand that Border Collie Rescue Texas, Inc. dogs are spayed or neutered or have a spay/neuter contract.  Border Collie Rescue Texas, Inc. reserves the right to refuse any applicant for any reason. 

By hitting the submit button below you agree to the above statement.