application

TRI-COUNTY COLLIE RESCUE OF MICHIGAN

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E-mail Address: *
Name, First & Last *
Age *
Spouse/Partner
Age
Address *
City *
State *
ZIP *
Home Phone
Secondary Phone
Best time to contact you	Morning Afteroon Evening
Best place to contact you	At Home At Work
Employer
Phone
Spouse/Partner Employer
Phone
Does either job require frequent travel out of town?	Yes No
Are you/spouse subject to relocation?	Yes No
Are you a student?	Yes No
If yes, anticipated graduation date:
Are you in the military?	Yes No
If yes, anticipated date of discharge:
Are you expecting a child or planning a family?	Yes No
How many children are living at home:
Child Name/Age
Child Name/Age
Child Name/Age
Child Name/Age
Child Name/Age
Child Name/Age
Other Person/Relationship
Other Person/Relationship
Is anyone allergic to animals?	Yes No
Does anyone have asthma?	Yes No
Do you own or rent your home?	Own Rent
If renter, exact name of owner:
If renter, phone number of landlord:
Dwelling type	House Condo/townhouse Duplex/Triplex Mobile Home Farm/Ranch Apartment Other
If other, please describe
How long have you lived at this address?
If less than 2 years, provide previous address:
Describe your neighborhood:	City Suburb Country/Rural
Does your home have a yard?	Yes No
Is the yard completely fenced?	Yes No
Do you also have a pen in the fenced yard?	Yes No
Describe fencing:
How tall is the fencing?
Is the gate locked with a padlock?	Yes No
Does the door that you will use to let the dog outside open directly into a fenced area?	Yes No
Can strangers gain access to the yard from the street?	Yes No
If you do not currently have fencing, are you willing to install fencing?	Yes No
If yes, what type of fencing?
By date?
We do not have fencing, we use a chain and dog house to keep the dog in the yard.	Yes No
If none of the above, explain how and where you will allow the dog to exercise and relieve itself?
Do you have other pets at this time?	Yes No
If yes, are ALL pets spayed or neutered?	Yes No
If no, please explain why:
Do you believe in using heartworm preventative?	Yes No
Other pets are	Indoor Outdoor
Pet 1 Type/Name/Age
Pet 2 Type/Name/Age
Pet 3 Type/Name/Age
Pet 4 Type/Name/Age
If you owned pets in the past and do not currently, what happened to them?
What role would you like your new collie to play in your life?	Companion/family dog Obedience Therapy Hunting Farm Dog Other
If other, please describe
Where does/would your dog stay when you are not at home?
Where does/would your dog stay when you are away at work or running errands?
Where does/would the dog sleep at night?
How many hours per day will the dog be alone?
Do you have a crate?	Yes No
Do you plan to use a crate?	Yes No
If no, please explain why
How many hours per day will the dog be crated?
What kinds of solutions would you be willing to try if housebreaking accidents occur?
If other, please describe
What kinds of solutions would you be willing to try if the collie was too busy or hyper?
If other, please describe
In terms of brushing, I am	up to a lot of brushing up to a little brushing going to use a professional groomer
Veterinarian Name/Address/Phone
Previous Veterinarian Name/Address/Phone
Groomer Name/Address/Phone
Trainer Name/Address/Phone
Personal Reference 1 Name/Address/Phone
Personal Reference 2 Name/Address/Phone
I am interested in the following collies from the website:
Please e-mail a copy of my application to the foster homes of the collies I am interested in.	Yes No
I/we prefer to be contacted by	Telephone E-mail
I/we are not currently interested in any of the dogs currently listed, please put us on the list for a dog that meets the following criteria: (age, sex, coat color, coat type)
Reasons for specifying the above, if any:
Any other information you would like to provide to help us make a match between you and your new collie:
I certify that	I understand that this application is only an interviewing tool, and my submission of this application in no way guarantees the placement or availability of a collie to my family. I understand that applications will not be returned. I understand that applications with unanswered questions will not be processed.


* Required