Today's Date:

First Name:     Last name:

Street Address:    City:   State:   Zip:

Phone:     Cell phone:     Email address:

Name and ages of all household members:

Are all household members in favor of this adoption? :  Yes No

What type of dwelling do you live in?  House Apartment Townhouse Condo Duplex Other

Do you rent or own? Own Rent If you rent you will be required to prove landlords contact information.

Do you have a fenced in yard? Yes No If yes, please describe your fence (height, type)

Please list all animals living with you (include small caged animals as well as livestock) and include the following: Pet's Name, Type, Age, Gender, Spayed/Neutered? How long owned?

Have you ever had to relinquish or surrender an animal in the past? If so please explain circumstances.

Please list contact information for a reference other than a relative:

Provide the name, address, and phone number of your current veterinarian:

If you currently have a dog, have you ever introduced it to a new dog before in your home? No Yes

If yes, please describe how he/she reacted?

What do you want to do with your border collie? To select multiple choices, hold down CTRL when you click.

House Pet Tracking Agility Herding Obedience Rally Flyball Frisbee Assisstance Dog Watch Dog Search and Rescue

What will your Border Collie need to get along with? To select multiple choices, hold down CTRL when you click

Dogs Cats Small Rodents Birds Men Women Small Children Loud noises Livestock Confusion and High activity

Where will your Border Collie be most of the time? .To select multiple choices, hold down CTRL when you click

Inside the house Outside in the yard Outside in a kennel In a crate

How will you contain the dog during your absences from home? To select multiple choices, hold down CTRL when you click

Crate Kennel Loose in the house Loose in the house with dog door Outside in yard Tied up
How many hours of the day will the dog be alone? Someone is always home 1-4 hours 5-8 hours 9-12 hours More than 12 hours  
Where will the dog sleep at night? 
How do you plan to exercise your Border Collie?

Have you investigated obedience trainers in your area? (training methods, facilities, previous experience) Yes No

Are you willing to enroll your new dog in training classes? No Yes

Have you ever owned a Border Collie Before: No Yes

What attracts you to the breed?

Describe the ideal BC or BC mix.

Do you object to a physical inspection of your premises and a personal interview? Yes No

If you are interested in a particular dog which one?

How did you learn of Skyway Border Collie Rescue, Inc?

If there is any additional information you feel is pertinent, please include it here: