GA Aussie Border Collie Online Application

I am interested in adopting:

Contact Information:
Your Name:
Address:
City:
State:
Zip:
Home Phone #:
Work Phone #:
Cell Phone #:
EMail:
Other Information:
Type of Employment:
Occupation:
Date of Birth:

Please answer all applicable questions by checking the appropriate boxes and providing any additional information which might help us evaluate the suitability of this adoption:

1.	Have you ever owned an Australian Shepherd or Border Collie before?	yesno
2.	Why did you choose this breed?
3.	What is/are your reason(s) for adopting this pet? (check all that apply)	family petchild's petwatchdoghunting dogcompanioncompanion for other petherdingagilityobedienceother
	If other, plese explain:
4.	Are you willing to allow GA Aussie Border Collie Rescue to visit your home and inspect where the dog will be kept?	yesno
5.	How long have you lived at your current address?
6.	How many times have you moved in the last 5 years?
7.	My home is:	apartmenthousecondo/townhousetrailer/mobile homeurban loftother
8.	Do you own or rent?	ownrent
	If you rent, does your landlord allow pets?	yesno
	Is there a pet deposit?	yesno
	If yes, how much?
	Have you already paid the pet deposit?	yesno
	Name of landlord or apartment complex:
	Landlord/apartment phone number:
9.	If you move, will your pet go with you?	yesno
10.	Would you consider moving somewhere that does not allow pets?	yesno
11.	Do you foresee any major life changes in the next 15 years?	yesno
	If yes, please explain:
12.	Can you provide a home for this pet for 10 to 15 years?	yesno
13.	How many adults live in your household?
14.	How many children live in your household?
	What are the gender and ages of the children?
15.	Do all members of your household know you are planning to adopt a dog?	yesno
	If no, please explain:
16.	Does anyone in your household smoke?	yesno
17.	Is anyone in your household allergic to animals?	yesno
18.	Does anyone in your household have any serious health problems?	yesno
	If yes, please explain:
19.	What procedure will you use for housebreaking?	crate trainingnewspaperrubbing nose in itswatting with newspaperoutside onlyother
	If other, please explain:
20.	What plans do you have for obedience training?	classesvideobooksin-home lessonsnoneother
	If other, please explain:
21.	Do you currently have any pets?	yesno
	If yes, please list type, name, age, sex and breed:
22.	How many pets have you owned in the past 5 years?
	Dogs:
	Cats:
	Other:
	Where are these pets now?	still with youdied of natural causesput to sleepsoldran waygiven awayadopted out to someone elseOther
	If any of these pets are not still with you, please explain:
23.	Have you ever had a serious behavioral problem with a pet?	yesno
	If yes, please explain:
24.	Has a dog died on your premises of distemper, parvovirus, or other causes in the last 3 months?	yesno
25.	Have you ever adopted a pet from GA Aussie Border Collie Rescue or any other animal shelter / humane society or rescue group?	yesno
	If yes, when and what happened to this pet?
26.	Do any of your current or did any of your past pets live primarily outdoors?	yesno
	If yes, please explain:
27.	Where will your new pet primarily stay?	insideoutside
28.	Will the new pet have access to the entire house?	yesno
	If no, where will this pet be allowed?
29.	Where will the new pet stay when home alone during the day?	basementgarageoutsidefree run of houseone room in housecratefriendfenced yardkennelother
	If other, please explain:
30.	Where will the new pet sleep at night?	basementgarageoutsidefree run of houseone room in housein my bedcrateother
	If other, please explain:
31.	Will your new pet be allowed on the furniture?	yesno
32.	Are all your current pets (if any) spayed/neutered?	yesno
	If no, please explain:
33.	Are all your pets vaccinations up to date?	yesno
34.	Do you know how to protect your pet from heartworm disease?	yesno
35.	If you currently have a dog, does he/she take heartworm preventative medicine?	yesno
	If yes, what kind?
36.	Do your current pets wear ID tags?	yesno
	If no, please explain
37.	How do you plan to protect your new pet from fleas and ticks?
38.	Do you have a current veterinarian?	yesno
	Vet's name:
	Vet's phone number:
	Can we contact them for a reference?	yesno
39.	Do you plan to take your new dog to the veterinarian for full preventive and medical care at least once a year?	yesno
40.	How much do you expect annual pet care to cost?(e.g. veterinarian costs, medication, vaccines..etc)
41.	Who will be responsible for the daily care of this new dog?
42.	What is the longest period of time your new pet will be home alone on an average day?
43.	Do you have a pet door?	yesno
	If no, would you consider installing one (if necessary)	yesno
44.	Is there a yard available?	yesno
	If yes, is it fully fenced without gaps?	yesno
	Fence Height?
45.	If there is no fence, would you consider fencing all or part of the yard as a condition of adopting a dog?	yesno
46.	If there is no fence, how do you plan to keep your new dog on your property when outdoors?	chainrunnertie-outleash walkpen/kennelrun freeother
	If other, please explain:
47.	Do you have a doghouse or other outside shelter?	yesno
48.	Under what circumstances do you think it is OK to leave a pet outside in an unfenced area without supervision? (check all that apply)	in a quiet subdivisionon a lot of acragein a rural areawhen I know they are trained to come backnever
49.	What do you plan to do with your pet when you go on vacation?
50.	If you date or marry someone who does not want your pet(s), what would you do?
51.	If your pet develops a serious medical condition which becomes expensive to treat, what would you do?	pay whatever it takesfind pet another homehave pet put to sleepgive pet to animal rescue group or shelterother
	If other, please explain:
52.	If your pet develops a frequent urination problem when it is older, what would you do?	have pet put to sleepconfine pet to one room give pet to rescue group or shelterother
	If other, please explain:
53.	What circumstances would justify giving up your pet? (check all that apply)	movingnew babynot getting along with childrennot getting along with other petsdivorcegetting out of fencebehavioral problemschildren lost interestfinancial issuesgot too bigtoo time-consumingsheddingallergiesbarkingmedical problemsother
	If other, please explain:
54.	How did you hear about our rescue efforts?	PetFinderweb searchfriendcustomer of Wiggles and Wagsother

By checking this box, I am attesting to the following:

I understand GA Aussie Border Collie Rescue requires this dog to be spayed or neutered.
I agree to contact GA Aussie Border Collie Rescue if I can no longer keep this dog.
I agree to properly license this dog and give him/her regular heath care.
I am willing to let an adoption representative to visit my home via appointment.
I am at least 21 years of age.
All of the information given is true.

Note: Any falsification on this application will be grounds for disallowing the adoption of rescue animals and possible removal of said animals from my home.