Organization

Applicant’s Full Name

Mailing Address

Street Address (if different than mailing)

City

State

Zipcode

Home Telephone

Mobile

Work Telephone

E-mail Address

Re-type (Confirm) E-mail Address

Names and ages of all family members,  roommates & anyone routinely at your home

Is everyone in household aware of your adopting a dog?

 Is anyone in your house allergic to dogs?

Housing type

 Do you own or rent?

 If renting, do you have the landlord’s permission to have a dog?

Do you authorize NCBCRA to verify permission to have a dog with landlord?

In the box below please provide landlord’s name, mailing address and phone number for permission verification. Please let them know of your application submission so they understand the purpose of our contacting them:

  Do you have a fenced yard?

Describe yard and fencing (type and height)

 Are you familiar with the local ordinances for dog ownership?

 May NCBCRA visit your home by appointment to review for dog safety?

How many hours a day will the dog be without human supervision?

What approximate percentage of time will the dog be outside?

What provisions will be made for your dog when no one is home during the day?

 Can you take your dog to work at all?

 Where will your dog sleep at night?

 Tell us about any other dog(s) at home (names, ages, temperaments, etc)

 Are all adult dogs in your household altered (i.e., spayed or neutered)?

 If any adult dogs are not altered, please explain why (or type in N/A)?

Please tell us of non-dog pets and livestock with which your border collie will coexist

Why do you want to adopt a border collie?

Describe your dog ownership, training and handling experience

Have you ever lost a pet (e.g., escaped from an enclosure)?  

Have you ever had a pet poisoned?  

Have you had an animal hit by a vehicle?  

Would you allow a dog to ride in the back of a pick up truck?

Have you ever had a pet die due to disease?

Have you ever owned a border collie?  

What training, activities and regular exercise do you plan for your border collie?

Under what circumstances would you  relinquish your dog to a shelter or rescue?

If you adopt a dog too young to be altered, do you agree to sign a contract to have it spayed or neutered at the appropriate age?

Are you prepared to assume the financial responsibilities of caring for an animal including vet care (emergency and routine), licensing, proper shelter and feed?

In the box below please provide your veterinarian clinic name, city and phone number:

Is the Border Collie going to be gift?

If yes, is the recipient aware ?

 How did you first hear of NCBCRA?

Date application submitted:

Thank you for applying to adopt a dog from Northern California Border Collie Rescue & Adoptions. After submission, please anticipate an email from us within 72 hours with your application review. If approved at that point the approval
would be a general one and your interest in a specific dog is then subject to review by the foster parent
based on the needs of that particular dog.