Collie Concern Rescue, Inc. Adoption Application

Submitted by happycollie on Tue, 04/21/2009 - 01:40.

Dear Applicant:

Our aim is to place needy Collies into loving, responsible, and qualified adoptive homes that will benefit both the dog and the adoptive family. We use your responses on this application as part of the evaluation process. Please answer all questions completely, giving details where applicable. To be considered for an adoption you must be at least eighteen years of age; have the knowledge and consent of all adults living in your household; have your landlord's name and phone number, if applicable; and understand that Collie Concern Rescue must approve your application. If you have questions, contact a CCR representative.

Please complete the adoption application along with the $10.00 application fee, to cover the adoption evaluation process. If the application is approved, the $10.00 application fee will be deducted from the adoption fee of:

$275 for most regular adoptions
Scholarships may be available on certain dogs to help them find a forever home.
These adoption fees defray the costs that we incur in the dog's vetting. They include spay/neuter, heartworm test (and treatment if necessary), heartworm prevention while they are here, Rabies vaccine, distemper vaccine, bordatella vaccine, at least 2 dewormings, Flea Treatments while they are here, any necessary grooming, microchip, full vet exam, and any other necessary veterinary work deemed appropriate by the vet. In addition, senior dogs may receive extra bloodwork and dentals.

If the application is not approved, or if you do not find a dog you wish to adopt from us, we will use the $10.00 as a donation to the rescue. Please understand that we will not process your application and you cannot talk to the foster parents or go to the foster homes to meet the dogs until we receive your fee.

For your convenience, you will have access to a payment page after submitting this form, but you can also pay by check, money order or cash to a representative. You can set this up when talking to your representative. Your application will not be approved until Collie Concern has your payment, so please remember to mention that you still need to pay your application fee!

Thank you for your interest in Collie Concern Rescue!

I authorize Collie Concern Rescue and its representatives to investigate all statements in this application.: *

I understand that CCR has the right to accept or deny my request as it deems appropriate. : *

First Name: *

Last Name: *

Co-applicant First Name:

Co-applicant Last Name:

Street Address: *

City: *

State: *

Zip: *

Primary Phone Number: *

Secondary Phone Number:

Email Address: *

We will be contacting you through email whenever possible - please give us your correct email address.

Occupation: *

Employer's Name and Address: *

How many adults live in your household?: *

How many children live in your household?: *

Are any of your children under age 5?:

Yes

Home situation - do you: *

If renting, do you have permission of your landlord and / or does your lease allow you to have a large dog?:

Yes

Landlord's Name and Phone:

Why do you want a Collie?: *

What characteristics do you desire in a Collie?: *

Have you ever met any of the Collies in our program? When and where?: *

Is there a specific collie on our website that you are interested in? Why does this collie appeal to you?: *

Are you aware that Collies need regular (at least weekly) grooming and that they shed a lot?: *

How did you learn about Collie Concern Rescue?:

Have you ever had a Collie before?: *

If yes, do you still have this Collie?: *

If no, what became of this Collie?:

Have you ever bred or raised dogs?: *

Are there any other pets in the household?: *

Please list and describe all pets you have had in the past 5 years:

If any pets are not spayed or neutered, please explain why they are not.:

If any pets are not on heartworm prevention medicine, please explain why they are not.:

Do you intend to invite the Collie indoors?: *

If unforeseen changes occur (e.g.: Moving) will you keep and care for the Collie? Do you have a plan for this?: *

Have you ever turned a pet in to a animal shelter or animal rescue? If so, what were the circumstances? How long ago?: *

If you cannot keep and care for the collie do you agree to return him/her to the care of Collie Concern Rescue?: *

Do you have a fenced yard/area for the Collie? Please describe:: *

How long will the collie be alone during the day on average? Where will the collie be?: *

Do the primary caregivers work? How many days per week? Will the collie be indoors or outdoors during this time? Are other pets home with the collie during this time? Crating?
This makes a difference for which collie we place into your home.

What resting / sleeping place is available for the Collie?: *

Have ALL members of the household DISCUSSED and AGREED upon getting a Rescue Collie?: *

1st Refrence First Name: *

References can not be related to applicants.

1st Refrence Last Name: *

1st Refrence email address:

Please provide email address if at all possible. Applications without reference email addresses can take an extra week or two to approve.

1st Refrence Phone Number: *

2nd Refrence First Name: *

References cannot be related to applicants.

2nd Refrence Last Name: *

2nd Refrence Email Address:

Please provide email address if at all possible. Applications without reference email addresses can take an extra week or two to approve.

2nd Refrence Phone Number: *

Veterinarian Name (current or if you have no pets, list your planned veterinarian): *

Veterinarian Street Address: *

Veterinarian City: *

Veterinarian State: *

Veterinarian Zip Code: *

Veterinarian Phone: *

Veterinarian Fax:

Veterinarian Email:

This space is optional and can be used in case you need any additional room for any answers.:

I certify that all information given is true, accurate and complete to the best of my knowledge. : *

I understand that any misrepresentation of facts could result in the loss of adoption privileges.: *

I agree to abide by all animal ordinances, leases, & property ownership agreements with regards to this adoption.: *

Yes

I agree to abide by all local animal ordinances, leases, and property ownership agreements as they pertain to the legally defined number of pets allowed in any human domicile or associated/attached properties. I further agree that, should I be in violation of any local animal ordinances, leases, and property ownership agreements pertaining to the number of animals allowed, I hold harmless Collie Concern Rescue in all matters, and assume all legal and/or financial liabilities pertaining to any violations of said ordinances, leases, and/or agreements.

I will tell my veterinarian that Collie Concern will call for a reference and that they have my permission to speek freely.: *

Yes

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Collie Concern Rescue, Inc. Adoption Application