Houston Collie Rescue
  Adoption Application

For the best match between Collie and family, as well as to protect our dogs, Houston Collie Rescue screens our applicants carefully. Please read our Terms of Adoption and take the time to answer our questionnaire carefully and thoughtfully. Thank you for your interest in adopting a rescue Collie.

Name: ___________________________________________
If married, Spouses Name: ___________________________________________
Address: _________________________________________
(Apt.): _________________
City: ________________ State: _______ Zip: ________
What area of Houston ____________________
Home Phone:(_____)______________________
Occupation: _____________________________
Work Phone: (_____)______________________
E-mail: __________________________
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? ___________________________________

2) Do you still have that dog? Yes: ___ No: ___ M/F ____ Age: _____
Spayed/Neutered? Yes: ___ No: ___
If no, please explain: ________________________________________
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 explain your responses below. During the last two years:
a. Have you lost a pet (not through death)?__________________
b. Have you had one poisoned?___________________________
c. Have you had an animal killed by a vehicle?_______________
d. Have you had an animal die due to disease?________________
     If yes, what did the animal die of? _______________________

5) For what purpose do you want this Collie? ____________________________________

6) Do you have any other animals? Yes: ___ No: ___
If yes, list type, age, and sex: ________________________________________________
_______________________________________________________
Are dogs spayed/neutered? Yes: ___ No: ___
Are cats spayed/neutered? Yes: ___ No: ___
If no, please explain:_____________________________________

7) Do you have children at home? Yes: ___ No: ___
If yes, Number: _______ Age(s): ___________________________

8) Do you live in a house? ___ Apartment? ___ Condo? ___Mobile Home? ___

9) Do you Rent? ___ Own? ___

10) If you rent, do you have the landlord's permission to keep a dog?
Yes: ___ No: ___
[Please attach 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: ___ Is it fenced? Yes: ___ No: ___
Good Condition? Yes: ___ No: ___
What type of fencing? Chain ___ Wood ___ Height _____
Other: (please describe) _________________________________
If you have a doggy door, does it open only into the fenced yard? Yes: ___ No: ___
Size of Door? Small: ___ Med:___ Large:___
If you live in an apartment/town home, is there a safe place to walk/exercise the Collie?
Yes: ___ No: ___

12) Is someone home during the day? Yes: ___ No: ___
Please explain: ____________________________________________

13) What provisions will be made for your Collie if nobody is home during the day?
Loose inside? ___ In crate? ___ In fenced yard? ___

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 ___?

16) Where will the Collie sleep? Please explain: _________________________________

17) Do you have a sex preference? Yes: ___ No: ___ Male: ___ Female:___
Would you consider the opposite sex? Yes: ___ No: ___

18) Do you have a color preference? Yes: ___ No: ___
Color: ________________________Second color 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, veterinarian care, good quality food, licensing, etc.?
Yes: ___ No: ___
Phone number and name of your Vet: (___)____________   ________________________
What name are medical records listed under at the Vet's Office? ______________________

23) Do you understand 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 explain._______________________________________
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? __________________________________________
If yes, 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?
Car: ___ Truck: ___ Van: ___ Other: _________________________

32) Are you prepared to do the extra grooming a Collie’s double coat requires?
Yes: ___ No: ___

33) Do you understand 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?
a. Internet Search ___
b. Vet, Clinic, Pet Store, or Shelter Referral ____  Name: ___________________________
c. Breeder ____ Name: _____________________________
d. Dog/Obedience Club ____ Name: ______________________________
e. Another Rescue Group ____ Name: ______________________________
f. Friend/Neighbor ____  Name: __________________________________
g. Other _____ (please explain) _____________________________________________

38) Do you accept that to defray our program expenses for rehabilitating your dog and to help the next rescue Collie there will be a $250.00 for all dogs age 1-9, $125 for dogs 10+, and $275 for all puppies under 12 months 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 (below). By signing 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.

Date: ________________
Signature: __________________________________
Signature: __________________________________

NOTE: If you are under 18 years of age, a parent or guardian must also sign this application. Thank you for considering a dog from Houston Collie Rescue.

Please return to:
Houston Collie Rescue
PO Box 526
Stafford, TX 77497-0526