* Name

* Street

* City

* State

* Zip

* Phone

* Email

* Date of birth

Collie's name

List dogs you own or have owned in the last 3 years

Breed(s)

Spayed/Neutered?

What has happened to him/her?

List cats

Do you have children? If so, what are their ages?

Vet name and phone

Do you have a fenced yard? Yes
No

If yes, describe the fence

Are your current pets on heartworm preventive, and the brand of medication?

Are you familiar with local animal ordinances? Yes
No

Does any member of your household have allergies? Yes
No

Do you plan to chain or tie your Collie outside at anytime? Yes
No

Are you employed? Yes
No

Are you or your spouse currently serving in the military? Yes
No

May I come to your home and visit this pet? Yes
No

Has your pet ever been taken to Animal Control? Yes
No

If yes, why, and did you redeem it?

Why do you want this collie?

Will your Collie be kept: Indoors
Outdoors
Both

Who will be responsible for this Collie?

What will you do with this Collie if it is not working out?

Do you Own/Rent If renting, provide name and phone # of landlord

Type of housing: House
Apartment
Mobile Home
Condo

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