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Date: ________________ Name of Collie you are interested in: __________________

Name: ___________________________________ Home Phone: ______________________________

Address: _________________________________ Work Phone: ______________________________

City: ____________________________________ Email: ____________________________________

Province: ________________________________ Postal Code: _______________________________

Is your residence a: __ House __ Mobile Home __ Apartment __ Townhome __Other

Do you own or rent your home: ___ Own ___ Rent

Note: If you rent your home your landlord must be willing to sign a document provided by CRN stating you are allowed to own a dog at this residence.

Do any children live/spend time here? ________

If yes, what are their ages? ____________________________________

Do you currently have any: __ dogs __cats ___birds __small animals __other

Are your current pets spayed/neutered? _______ Are your current pets vaccinated? _________

Describe your current pets: ____________________________________________________________
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Who will be your veterinarian? _________________________________________________________

Phone number of current/planned veterinarian: __________________________________________

*Please inform your vet that a representative from CRN may call for basic care information*

Why are you interested in adopting a Collie? _______________________________________________

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What traits/behaviours are important to you? Please list any additional traits in the Other section.

__ Quiet	__Housetrained	__Crate Trained	__Can be left alone
__Barks to alert	__Minimal Shedding	__Friendly with Strangers	__Knows basic obedience
__Good with dogs	__Good with cats	__Good with kids under 5	__Good with kids 5+

Other: _______________________________________________________________________________

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Gender Preference: __Male __Female __No Preference

Coat Preference: __Rough __Smooth __No Preference

Colour Preference: __Sable __Tri __Blue __White

Age Preference: __Under 1 year __ 1-4 years __5-8 years __9+ years __No Preference

During the day the dog will mainly be: ___________________________________________________

At night the dog will sleep: ____________________________________________________________

Is your yard fully fenced? ______________

If yes, describe fencing: ______________________________________________________________

If no, how will you contain the dog? _____________________________________________________

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

Who will be the main caretaker of the dog? ______________________________________________

Will you attend obedience classes with the dog? __________________________________________

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

Have you ever adopted from a rescue or shelter before? ___________________________________

If yes, whom? ______________________________________________________________________

Have you ever been denied an adoption from a rescue or shelter before? _____________________

If yes, why? _________________________________________________________________________
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How do you spend your free time? _______________________________________________________

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Is there anything else you would like us to know about your home, your lifestyle, your family or your current pets that might help us better match a Collie to your family? ____________________________

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Important Information Below - Please read carefully before sending this application

Do you understand that Collie Rescue Network make 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 ___ No
Do you understand that Collie Rescue Network requires a minimum $275.00 adoption donation to partially off-set the some of the costs incurred by the Collie with in the rescue program? ___Yes ___ No
Do you understand that the completion of this application form is in no way considered approval or acceptance as an adopter and is only used as a tool and that Collie Rescue Network reserves the right to refuse any adoption, at any time, for any reason? __ Yes __ No
Do you state that all the information on this application form was filled in by the person(s) applying to adopt a dog from Collie Rescue Network and that all the information provided is true and accurate to the best of your ability? __Yes __No

_____________________________________ Signature of person applying to adopt

_____________________________________ Date