Applicant's full name: *
Age:
*
Spouse/Partner's full name:
Age:
Address:
*
City:
*
State: *
AL
AK
AS
AZ
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip code: *
Home phone:
Cell phone:
Work phone:
Best time and number to call:
*
Spouse/Partner's occupation:
Members of Household
Age:
Age:
Age:
Age:
Age:
If yes please list below:
Which family member(s) will be caring for your new dog:
*
Relationship to you: *
Phone: *
E-mail:
Relationship to you: *
Phone: *
E-mail:
Relationship to you: *
Phone: *
E-mail:
Veterinarian:
*
Address:
*
Phone: *
If yes how many:
1
2
3
4
5
6
7
8
9
10
How long have you lived at this address:
If yes how many pounds?
If yes how many?
Landlord Contact Information
Name:
E-mail:
Address:
Phone:
Alt Phone:
Care of Pet(s)
If none please explain:
What form of discipline will you use on your dog:
*
When you go on vacation, where will your dog go and who will care for it:
*
If you move, what will you do with your dog:
*
What concerns do you have about the adjustment period for a new dog:
*
Is there a circumstance that would cause you to give up a dog:
*
How much do you expect to spend each year on veterinary care:
*
How much do you expect to spend each month on food, grooming, etc:
*
What kind of food do you currently feed or would you feed:
*
Do you have a securely fenced yard:
*
Height and type of fence:
*
If you do not have a securely fenced yard, how will the dog be safely exercised and let outside to relieve itself:
*
Where will you keep your dog when left alone:
*
Where will your dog sleep:
*
Including commuting time, how many hours per day will the dog be alone:
*
If approved for adoption, will your new pet primarily be kept indoors or outdoors:
*
Please list all current pets and be specific with type/breed, name, age, if the pet is altered (S/N) and how long you have had this pet:
*
Are all current animals up to date on vaccinations:
*
Please list all pets you have owned previously and be specific with type/breed, name, age, was the pet altered (S/N), how long you had the pet and what happened to them:
*
If yes please explain:
Have you ever owned a Border Collie or Australian Shepherd before? If not, what previous experience, if any, have you had with these breeds:
*
Why did you choose this breed:
*
Are you interested in a particular dog and why:
*
Are you applying at other rescues? If so, which ones:
*
Where did you hear about North Star Border Collie Rescue:
*
Any additional information you would like us to know about you and your family:
WE RESERVE THE RIGHT, IN OUR SOLE DISCRETION, TO REFUSE ANY APPLICANT FOR ANY REASON WHATSOEVER
Applicant Agreement
Without your electronic signature, we cannot process your application. Your electronic signature will be evidence of your acceptance of the terms and conditions set forth in this application
*
Date:
*