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Adoption Application Form

If married, Spouses Name:
Street Address:
Apartment Number:
What area of Houston or Texas:
Home Phone:
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 

If yes, do you still have that Collie dog? Yes   No 

If no, please explain why you no longer have previous collie.

If you have never owned a Collie, have you done some research to learn about the breed?      Yes   No 

2. Do you currently own other dogs, other breeds?   Yes   No 

Please list the sex, age and spayed/neutered status of each dog that you currently own:

3. If any of your current dogs are not spayed/neutered, please explain:

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 types of 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
(We will require proof 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. What is your size preference?

21. Would you consider a Collie-mix? Yes    No

22. 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

23. 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?

Please let your clinic(s) know we will be calling to make sure your pets have been kept up to date in their vaccinations, heartworm preventative, and annual heartworm tests. Additionally, please read carefully: if dog owners purchase their Heartworm preventative on line rather that at a clinic, we will need proof of purchase such as a receipt. Furthermore, dog owners need to know that most heartworm preventative manufacturers will not cover the treatment if the pills are purchased on line and fail, as they have no way of knowing for sure those were actually their products.]

I hereby authorize the veterinarian(s) named herein to release information about me or my pet(s) to Houston Collie Rescue, Inc. as necessary to evaluate this application. [In order for the application to be considered, all veterinary records for current resident pets must be complete and up to date; all resident dogs and cats must be vaccinated, and dogs must be on heartworm preventative. There are no exceptions to this requirement, so if the records indicate the pets are not up to date, HCR will not proceed with the adoption process.]

24. Do you understand and accept that the Collie you adopt must be kept on monthly heartworm and flea preventative? Yes    No
25. 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

26. 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.

27. Are you familiar with the animal control regulations in your area? Yes    No

28. 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

29. Do you understand that Collies are known for being "barkers"? 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‚Äôs 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 dog?

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. Houston Collie Rescue works closely with other rescue groups around the state and nation, doing referrals and also deferring to these groups' in service areas. If you are applying to other rescue programs as well, please advise us of that and which ones.
39. Do you accept that to defray our program expenses for rehabilitating your dog and to help the next rescue Collie there will be a $275 donation for an adult age 1-9; $300 minimum, not to exceed $500 for puppy under 12 months, $125 for adult age 10+, payable immediately by check, cash, or money order upon adoption and delivery of the adopted Collie?

Yes    No

Puppy pricing varies on a case by case basis and will be disclosed upon inquiry and prior to adoption.

Please note that all Collies or Collie mixes are considered equals within our program.

40. Do you accept that the adopted dog may not be transferred to another party and that if the dog must be given up for any reason, he or she is returned to Houston Collie Rescue ?

Yes    No

I have read and am in full agreement with the Houston Collie Rescue, Inc. Rescue Program Terms of Adoption. By selecting "YES" below I am attesting to the truthfulness of my answers. I agree the adopted dog shall not be kept exclusively outside, will be on regular heartworm and flea preventative for life, and will receive good nutrition, all vaccinations and normal health care. I understand that falsification of any of the above information will be grounds to disallow the adoption of a rescued Collie. I further understand that Houston Collie Rescue, Inc. Program will always be interested in our adopted dogs welfare and progress and would appreciate updates. I will also provide the coordinators with new e-mail addresses, changed home addresses and phone number as they occur.

Yes, I Agree With These Terms And Conditions.

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