*First Name:
*Last Name:
*Address:
*City:
*State:
*Zip:
*E-mail:
*Home Phone:
format (###) ###-####
Cell Phone:
format (###) ###-####
Work Phone:
format (###) ###-####
Employer:

Please leave this field empty:
Name of Dog(s) of Interest:
(if applicable)
* What role would you like your new collie to play in your life?
(select as many as apply)
Companion for Self
Companion for Child
Companion for Pet
Obedience/Agility/Herding
Therapy
Farm Dog
Other
If "Other", please describe:
*Select Your Residence:   *Own   Rent
*Describe Your Yard:
Landlord's Name/Phone:
(if applicable)

Please List All People Living in Your Home:
(including yourself)
Name Relationship To You Age
* *
*Describe Your Daily Schedule:
*Do You Prefer: Male    Female   No Preference
*Traits You Prefer:
(Energy Level/Training/etc.)
*Behaviors That Will Concern You:
Please List All Animals Living in Your Home:
Name Breed Age Gender
*Have You Had Pets Before?
Please tell us what you've had and where they are now:
*Name & Phone of Veterinarian
you currently use, used previously, or plan to use:
Please list two references that we may contact
about your animal care experience and dedication:

 *1.  
  2.  
Additional Info that will help us find the right pet for you:
*How did you find out about us?:
*I certify:
  • I have read the Adoption Guidelines.
  • The information that I provided in this questionnaire is correct to the best of my knowledge.
  • All members of my household have never been charged with cruelty to animals.