NorCal Collie Rescue

PERSONAL AND HOUSEHOLD INFORMATION

Date of Application

Are you applying for a specific dog? If so, what is it's name?

Name
Address
City, State, Zip
Email Address
Daytime Phone
Evening Phone
Best time to call

May we call you at work?

Who lives in your home?
What are the ages of each person in your home?
What are the ages of frequent visitors, if they are minors, and how often?
How long have you lived at your current residence?
Are you planning a move in the foreseeable future?
If you were to move, would you insist on a new house having a fenced yard?
If you were to move, what would happen to your adopted dog?

Do you own or rent?
What type of home do you live in?
If Other, please explain:
Does you home have any steps and/or stairs?
If Yes, please explain/describe:
What is the speed limit of the road you live on?
Please define your household: (Check all that applies)	My household is: Busy (visits by friends, children, parties) Noisy (TV, Stereo, machinery, tools, children playing) Moderate (normal comings and goings) Quiet ("homebodies", few guests, stay home a lot) Lots of children in the neighborhood Live on a busy street or highway

PET OWNERSHIP INFORMATION

Have you ever owned a Collie?
Would barking be an issue in the area surrounding your home?
Are you aware that a Collie is a double-coated breed that will shed?
Our dogs must be allowed inside with their family, but on the occasion they are left outdoors temporarily, what kind of shelter will be provided?
Do you have a fenced yard?
If Yes, what type of fence?
If Yes, how high is your fence (at the lowest point)?
If Yes, does a door from the house open directly into the fenced yard?
How will your dog access the area for relieving himself/herself?
Are they any pools, jacuzzis or ponds on your property?
If Yes, please explain/describe:
If Yes, is it child fenced or have a child proof pool cover?
If Yes, please describe fence/cover:
Where will your dog sleep at night?
Are dogs allowed on your furniture?
How many hours a day will your dog be left alone?
How will you allow your dog to run and get exercise?
What brand and type of dog food do you plan on feeding your new Collie?
If you do not know, will you feed dog foods recommended by NCR?
Have you previously owned a dog and if so what happened to the dog?
Do you currently own any pets?
If yes, please provide us with the following information:

Do you currently have a Veterinarian?
If Yes, please provide his/her name and phone number:
May we contact him/her for a reference?
Do you have the time and/or patience to train a dog if it not already trained?
Will you take your new dog to obedience class if we recommend it?
How often do/did your dogs get groomed?
Are you willing to crate your adopted dog when traveling in a car or provide a car harness?
Dogs are fostered all over Northern California. Are you willing to travel to meet and transport the dog to your home?
AKC reports it costs over $1,000 or more per year to properly care for a dog, which includes, but not limited to: vet care, medications, food, licensing, shots, grooming, etc. Are you aware of this financial responsibility of dog ownership?
What is the primary reason you want a Collie?
Will you agree to a "home check" by a NCR volunteer?

PREFERENCES

Do you have a color preference?
Do you have a coat preference?
Do you have an age preference?
Do you have a gender preference?
Would you be willing to take a "Special Needs" (shy, handicapped, medication, behavior problem) dog?

MISCELLANEOUS INFORMATION

Have you submitted an application with any other rescue group?

If you have contacted a NCR volunteer already, please tell us who:

Any other Comments, Questions, or Concerns?
(Your typing space is unlimited so please feel free to type as much as necessary)

To validate human entry of this application, please type the word DOG in this box: