Far Point Collie Rescue
1035 Red Hill Road
Port Trevorton, PA 17864
570-374-2742
Application for Adoption
Adopter’s Name _______________________________________________
Occupation: ___________________________________________________
Employer: _____________________________________________________
How long? ___________________ Employer’s phone: ________________
Spouse’s Name ________________________________________________
Spouses’s employer: ____________________________________________
Children? (names and ages) _____________________________________
Complete Address _____________________________________________
Home Phone ____________ Work Phone ___________ Cell ___________
Email Address _________________________________________________
Name/breed of dog you are interested in adopting __________________
Have you ever been convicted of a crime dealing with animal abuse? If
Yes, please explain. _____________________________________________
Does your job require you to travel or move? If your job requires
you to travel, explain how long absences generally are and who will care for your pet(s) while you are gone. ________________________________________________________________
________________________________________________________________
If you do adopt from us, where would the dog be kept while you are at
work? _______________________________________________________
Do you own your own home or rent? If you rent, please provide the
name and phone number of your landlord. _____________________________________
How long have you lived at the current address? ___________________
Describe area in which you live – country, city, suburb, development,
high traffic area, etc. __________________________________________
Describe your yard
Approximate size: _____________________________________________
Fence type and height: __________________________________________
If the yard is not fenced in, how will you ensure that the dog does not stray?
Please list all current pets: (dogs, cats, birds, reptiles, etc.)
Species
Name Age
Spayed/Neutered (Y/N) Sex
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________|
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Where will the dog stay when no one is home? (please be specific –
crate, gated in kitchen, free roam of house, etc.) ___________________________________________
How many hours will the dog be left unattended in an average day?
Where would the dog sleep at night? ______________________________
What type of exercise would the dog get, and how much time would the dog spend outside? (approx)_______________________________________________
What brand of dog food do you intend to feed the dog (be specific)?
How will you housebreak the dog? (If applicable) Are you familiar
with crate training? What are your thoughts on it?
Who will be responsible for feeding, housebreaking and training?
Does anyone in your home have allergies? Yes _____ No _______
If “yes”, please explain: ______________________________________________
If your interest is in a collie, which of the following are you looking for?
Color (Sable, Tri, Blue): _______________ Age _______ Sex _____________
Name, address and telephone number of your veterinarian _________________
___________________________________________________________________
Personal References: (Please use people that you have known for at least 2 years & one being a neighbor)
Name ____________________________________
Phone _____________________
Relationship to you _____________________________________________
Name ____________________________________
Phone _____________________
Relationship to you _______________________________________________
What do you think are the most important responsibilities in owning a pet?
Tell us a bit about yourself ________________________________________________________________________________________________________________________________________________
________________________________________________________________________
Will you keep Far Point Collie Rescue informed of any moves, illnesses, escapes or death of any collie (or other
breed you adopt from us) entrusted in your care?
YES ______________ NO ______________
By signing this form, I attest that the information that I have provided is the truth to the best of my knowledge
and belief. I also understand that completing this form in no way guarantees
me, nor obligates me to adoption of the pet named above. Be advised that a Home Visit with all
household members is a pre-adoption requirement. My signature below means
all information listed on this application is correct as I know it now.
____________________________________________________ ________________
(Signature)
(Date)
Please return this form to your local rescue contact or mail to:
Yvonne Roadarmel
Far Point Collie Rescue
1035 Red Hill Road
Port Trevorton, PA 17864
