Date:                       Name of Collie you are interested in:

Is your residence a House Mobile Home Apartment Townhouse Other                                 Do you own or rent your home? Own Rent Other

*If you rent, your landlord must be willing to sign a document provided by CRN stating they will allow you to own a dog at this property*

Do children live/spend time there?  Yes, kids live here No kids live/visit here Kids visit here

If there are children living or visiting this home, what are their ages?

Do you currently have any:    dogs     cats     small animals    birds     other pets/animals

Are your current pets spayed/neutered?    Yes No             Are current pets vaccinated?  Yes No

Describe your current pets, if any:

Please list the contact information for the veterinarian you would be using for a Collie from CRN:

*please notify your vet that a representative from CRN may be calling them for basic care information*

Why are you interested in adopting a Collie:

What traits/behaviours are important to you?  Please list additional traits in the "other" area:

Gender Preference:   Male     Female     No preference

Coat Preference:   Rough     Smooth     No preference

Colour Preference:  Sable     Tri     Blue     White     No preference

Age Preference:  Under 1 year     1-4 years     5-8 years     9+ years     No preference

During the day this dog will mainly be: Inside Outside Garage Other            At night this dog will sleep:  Inside Outside Garage Other

Is your yard fully fenced?  Yes No        If yes, please describe the fencing:

If your yard is not fenced, how will you contain the dog on your property?

How many hours per day will the dog be left alone?

Who will be the main caretaker of this dog?

Would you attend obedience classes with a rescue Collie?

If you ever move, what will you do with the dog?

Have you ever adopted from a rescue or shelter before? Yes No

If yes, from whom?

Have you ever been denied an adoption from a rescue or shelter?  Yes No

If yes, why?

Important Information Below - Please Read Carefully Before Submitting This Application

1. Do you understand that Collie Rescue Network makes NO warranties concerning the temperament, habits, health or behaviours of any Collie you may choose to adopt and all adoptions are based solely on your own judgement.       Yes, I understand and agree       No, I do not understand and/or agree

2. Do you understand that Collie Rescue Network requests a minimum $350.00 adoption donation in order to help off-set some of the costs incurred while the Collie was was the rescue program?                                          Yes, I understand and agree     No, I do not understand and/or agree

3. Do you understand that completion of this application form is in no way considered approval or acceptance as an adopter and is used only as a tool and that Collie Rescue Network reserves the right to refuse any adoption, at any time, for any reason.                                                                                                                      Yes, I understand and agree     No, I do not understand and/or agree

4. Do you state that all the information provided on this form was filled in by the person applying to adopt a dog from Collie Rescue Network and that all the information provided is true and accurate to the best of my abilities?    Yes     No