Houston Collie Rescue: Adoption Application

Mission Critical, Foster Homes Needed!

Adoption Application Form

Name:
If married, Spouses Name:
Street Address:
Apartment Number:
City:
State:
Zip:
What area of Houston:
Home Phone:
Occupation:
Work Phone:
Cell Phone:
E-mail Address:
Name of Collie(s) that you are most interested in?
Alternate Collie(s) that you may be interested in?
1. Have you ever owned a Collie? Yes No
2. Do you still have that dog? Yes No If yes, please complete the next two boxes. If no, please complete the third box only. Please list the sex, age and spayed/neutered status of each Collie that you currently own: If any of your current Collies are not spayed/neutered, please explain: If no, please explain why you no longer have the dog. If you have never owned a Collie, have you done some research to learn about the breed? Yes No
3. What happened to your last Collie?
4. Please give a detailed response to a yes answer given to any of the following questions. During the past two years have you lost a pet (not through death)? During the past two years have you had a pet poisoned? During the past two years have you had a pet killed by a vehicle? During the past two years have you had a pet die due to disease? If so, what disease(s)?
5. For what purpose do you want this Collie?
6. Do you have any other animals? Yes No If yes, list type, age, sex and spayed/neutered status of each: If any of these animals are not spayed/neutered, please explain:
7. Do you have children at home? Yes No If yes, please list the age of each child:
8. Do you live in a House Apartment Condo Mobile Home
9. Do you rent or own your residence? Rent Own
10. If you rent, do you have the landlord's permission to keep a dog? Yes No (please send in a copy of the landlord's permission) If you rent, do you understand the dog must be exercised on a leash in a safe place? Yes No
11. Do you have a yard? Yes No If yes, is the yard fenced? Yes No If yes, is the fence in good condition? Yes No Describe the height and type of fencing (wood, chain, other): If you have a doggy door, does it open only into the fenced yard? Yes No Size of doggy door: If you live in an apartment/condo, is there a safe place to walk/exercise the Collie? Yes No
12. Is someone home during the day? Yes No
13. What provisions will be made for your Collie if nobody is home during the day?
14. What provisions will be made for your Collie in the case of an unforeseen emergency event?
15. Do you intend to keep the Collie primarily indoors or outdoors? Indoors Outdoors
16. Please explain where the Collie will sleep?
17. Do you have a sex preference for your Collie? Male Female No Preference If yes, would you consider the opposite sex? Yes No
18. If you have a color preference, please list your first and second choices: First choice Second choice Note: Due to the popularity of Blue Merles, we do not see them often in rescue.
19. What age range would you prefer? Would you consider an older Collie? Yes No If Yes, to what age?
20. Would you consider a Collie-mix? Yes No
21. Are other members of your household aware that you are considering adopting a Collie? Yes No Does everyone in your home want this Collie? Yes No
22. Are you prepared to assume the financial responsibilities of caring for a Collie, including inoculations, heartworm preventative, veterinary care, good quality food, licensing, etc? Yes No Name and phone number of your Vet: What name are medical records listed under at the Vet's Office?
23. Do you understand and accept that the Collie you adopt must be kept on monthly heartworm and flea preventative? Yes No
24. Are you planning to move in the near future? Yes No If yes, please provide more details: If yes, are you willing to give HCR the new address? Yes No
25. Is anyone in your house allergic to animals? Yes No If yes, please explain how the allergy will be treated if you are bring in a Collie.
26. Are you familiar with the animal control regulations in your area? Yes No
27. Is this Collie going to be a gift? Yes No If yes, for whom? Does this person know he or she is getting a Collie? Yes No
28. Do you understand that Collies are known for being "barkers"? Yes No
29. Do you have plans to have any dog de-barked? Yes No
30. Do you understand that Collies can be shy and aloof with new people? Yes No
31. How will you transport a Collie?
32. Are you prepared to do the extra grooming a Collie’s double coat requires? Yes No
33. Do you understand and accept that any rescue Collie that you may adopt through Houston Collie Rescue will be spayed/neutered? Yes No
34. When you need to discipline the Collie, how would you do it?
35. What circumstances, in your mind, justify ‘giving up’ a Collie?
36. Are you willing to allow a Houston Collie Rescue representative to visit your home by appointment? Yes No
37. How did you hear about Houston Collie Rescue?
38. Do you accept that to defray our expenses for rehabilitating your Collie and to help the next rescued Collie that the donation fee shall be $250.00 for dogs under age 10, $125 for senior dogs over age 10, and $275 for puppies under 12 months, $125 for Collie Mixes whereas the donation is payable immediately by check, cash, or money order upon adoption and delivery of the adopted Collie? Yes No
I am in full agreement with the Houston Collie Rescue Terms of Adoption (click here to review). By selecting "YES" below I am attesting to the truthfulness of my answers. I agree the adopted Collie shall not be kept exclusively outside. I understand that falsification of any of the above information will be grounds to disallow the adoption of a rescue Collie. Yes, I Agree With These Terms And Conditions.

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