First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone*

Cell Phone*

Do you RENT or OWN your home? Please indicate the type of residence (e.g., rent apartment townhouse; own home, condo, trailer, etc.) If renting, do you have the landlord’s permission to get a dog? *

Is your home suburban, urban or rural?*

Do you have a fenced yard? If so indicate the type of fencing (height, wood, chain link, etc.) and size of fenced area. If not, please indicate how you will exercise the dog in a safe and controlled manner. *

Do you have any livestock? If so, what kind?*

Are you interested in a particular dog(s) listed on the Mo-Kan Border Collie Rescue site? If so, which one(s)?*

Who will be responsible for the care of the dog?*

Where will the dog be during work hours and when no one is home?*

Do you intend to keep this dog primarily INDOORS or OUTDOORS? What shelter will be provided for the dog if/when outdoors?*

In your opinion what are legitimate reasons for rehoming/surrendering a dog?*

Have you ever had to rehome or surrender a dog? If yes, why and what did you do?*

What happened to your last dog?*

In the event that you are no longer able to care for your dog, do you have a contingency plan in place for their care?*

Have you ever owned a border collie?*

Why do you want a border collie?*

Please give a brief description of the type of dog you are looking for (ie, sex, color, pure or mix, age, activities such as ball, Frisbee, herding, etc.)*

Have you ever completed obedience training and/or crate training with a dog?*

Please list the names AND AGES of ALL family members living in your household. Including yourself. **Age is required.*

Is anyone in the household allergic to pets?*

Does everyone in the household want a dog?*

Please list other pets in the household. Include their name(s), age(s), breed(s), species, and if spayed/neutered.*

What are your family's daily hobbies and activities?*

Please indicate daily work or school hours of all individuals and indicate if anyone is at home during the day.*

Please list your veterinarian's name, address and phone number (we will contact them for references.) If you don’t have a current dog, please state who you previously used and what you did for your previous dog.*

Provide date of most recent vaccinations/tests. Include Rabies, DHLPP and Heartworm test. *

What type of flea/tick prevention do you use? *

Do you use Heartworm preventative, if so, how many months of the year and what kind? Where do you purchase it and who is the prescribing veterinarian? If not purchased through a veterinarian, then purchase documentation will need to be provided. *

What food do you feed? How many times a day?*

What kind of exercise do you plan on providing the dog? How often will you provide?*

Are you willing to allow a rescuer to complete a home visit by appointment?*

Please list any other information you would like to add in order to help us match the right dogs with your family.*

How did you hear about Mo-Kan Border Collie Rescue?*

Do you have any additional comments?*

Do you acknowledge that there is an adoption donation amount and it is based on the age of the dog? The age will be determined by Mo-Kan Border Collie Rescue at the time of adoption. The amount will be: $350.00 – Under 8 years old; $250.00 – 8 years & older. And do you acknowledge that if adopting a puppy there will an additional $250.00 spay/neuter deposit?*

Do you understand that it is your responsibility to pick the dog up in person?*

For purposes of promoting the rescue, I agree to allow photos and/or first names of me and/or my family members to be posted on Mo-Kan's website and/or Mo-Kan's social media.*

I attest to the truthfulness of my answers. I understand that falsification of any of the above information is grounds to disallow me from being a part of Mo-Kan Border Collie Rescue.*