How did you hear about Northeast Border Collie Rescue?
Please list the adults in your household, their relationship to you, their
occupations and their ages:
Do they agree with your decision to get a dog?
Yes
No
If not, please explain:
Are there children in your household?
Yes
No
If yes, please list their ages:
Will they be responsible for caring for this dog?
Yes
No
Are there children in your neighborhood?
Yes
No
Are you frequently visited by children?
Yes
No
Do any children have access to your yard/kennel/house when you are not at
home? Yes
No
If yes, please explain how you intend to prevent them from teasing a dog,
letting a dog out either intentionally or accidentally, or doing anything that
might be detrimental to the welfare of a dog in your care.
Is anyone in your home allergic to animals?
Yes
No
Is anyone in your home afraid of dogs?
Yes
No
Is anyone in your home elderly or frail?
Yes
No
Your Neighborhood
Is your neighborhood
Rural
Suburban
Urban
Do you you live in
Apartment
Condo
Mobile Home
Single-family Home
Military Housing
Do you Own
Rent your property?
If you rent, do you have permission from your landlord to have
pets on the property? Yes
No
Do you live in a development or other area where there are
houses nearby? Yes
No
Do you share a house with other families?
Yes
No
Are there neighbors nearby who would be upset by a barking dog?
Yes
No
Are they aware that you intend to adopt a dog?
Yes
No
Are there any restrictions to the number of dogs and /or cats or
combination that you may have at your residence?
Yes
No
If yes, please explain:
How large is your property?
Do you own livestock?
Yes
No
If yes, please describe:
Do you have cats or other animals living in your house?
Yes
No
If yes, what kind and how many?
Is there a busy road nearby?
Yes
No
Do you have a fenced yard or outdoor kennel?
Yes
No
Please describe any fencing, including its height, and the size
of the area it encloses:
Are you willing to allow one of our representatives to come to
your house for a home visit and evaluation?
Yes
No
Your Experience With Dogs
Why do you want to add a dog to your family at this time?
Why do you want to own a Border Collie?
Have you owned a dog before?
Yes
No
If yes, what breed, when and what happened to this dog:
Have you ever owned a Border Collie before?
Yes
No
If yes, when and what happened to this dog:
Briefly explain your understanding of the nature of a Border
Collie, their special needs and how you will be able to meet those needs:
Your Current Dogs
Do you own a dog now?
Yes
No
If yes:
Breed
Spayed/Neutered? Yes
No
If yes, at what age?
Sex
Age
How long have you owned this dog?
Please describe your dog's temperament, particularly with
regards to other dogs:
Is your dog current on all vaccinations?
Yes
No
Has it been tested for Heartworm/Lyme disease?
Yes
No
Is it on any Heartworm Preventative?
Yes
No
Is it licensed in your town?
Yes
No
Have you ever adopted an animal from a shelter or rescue group?
Yes
No
If yes, please give the name and address of the rescue group:
Have you ever surrendered an animal to a shelter or rescue
group? Yes
No
If yes, please explain:
If yes, please explain:
Have you ever been bitten or attacked by a dog?
Yes
No
If yes, please explain:
Are you comfortable approaching unfamiliar dogs?
Yes
No
If behavior problems arose in your dog, how would you deal with
them?
Are you familiar with the animal regulations in your area?
Yes
No
Do you know the requirements for obtaining a dog license in your
town? Yes
No
Please list the names, phone numbers and /or email addresses,
and their relationship to you and your dogs of three people who are
knowledgeable about you and your care of dogs (i.e. trainer, kennel owner or
groomer) Please include your vet as one of these references.
Your Preferences In A Dog
Age: Gender:
Would you consider a dog that is five years old or older?
Yes
No
Would you consider a cross?
Yes
No
Would you consider more than one dog?
Yes
No
Do you want a dog for herding, search and rescue or other work?
Yes
No
If yes, please specify:
Do you want a dog for formal canine sport or competition?
Yes
No
If yes, please specify:
Are you looking for a companion dog?
Yes
No
Would you consider adopting a dog with physical problems like
hip dysplasia or epilepsy if the disability maybe controlled or treated with
medication or surgery? Yes
No
Would you consider adopting a dog with an emotional problem such
as separation anxiety, fear or aggression if it may be controlled or managed
with training, behavior modification, and/or the use of medication?
Yes
No
After researching Border Collies, are there any traits in the
breed that you would prefer to avoid?
Yes
No
If yes, please be specific and describe:
Is there a particular dog in NBCR that interests you? If
so, which one and why do you feel this dog is a good match for you?
Are you contacting other sources in your search for a dog?
Yes
No
If yes, which one/s?
Are you willing to wait for the dog that is the best match for
you and your lifestyle or do you want a dog NOW? Please explain.
How far are you willing to travel to meet a dog?
Your Lifestyle
Is there someone at home during the day on most days?
Yes
No
Approximately how many hours per day and on how many days will
your dog be left alone?
Will the dog live in the house with the family?
Yes
No
If not, where will the dog be staying during the day and night?
If you are away during the day, where will the dog stay?
If you are away for an extended period of time (overnight or
longer) where will the dog stay?
Will the dog be allowed to run loose at anytime?
Yes
No
Will you have your dog on a run, trolley or tied out at any
time? Yes
No
If yes, please explain when and for how long:
Are you planning to enroll your dog in obedience training
classes? Yes
No
If not, how will you train your dog? Please give a detailed
description of your previous experience training dogs and the training methods
you use.
How much are you willing to spend on vet care for your dog each
year?
What do you consider normal vet care for a dog?
How do you intend to adequately exercise your dog, both mentally
and physically?
Please add any information about yourself that you think would
be useful in helping us select the right dog for you:
I attest to the truthfulness of my answers. I understand
that falsification or fabrication of any answers will be reason for NBCR
to reject my application to adopt a Border Collie through NBCR. I
understand that NBCR has the right to refuse any applicant.
Signed:
Date: