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Full Name *
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Address *
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City/State Your In *
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Phone
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Rent or Own *
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If renting, do you have WRITTEN permission to have a house dog on the premises? We will require a copy - *
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Email Address *
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Describe area where you live (rural, suburban, ect...)
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Names, ages, and professions of ALL household members
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Describe your home, lifestyle and activity level (also that of the other family members)
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Who will be the primary caretaker and handler for this dog
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Please list all family pets (include name, breed and age) and any livestock you currently own
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What type of fence?
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Which ACD are you interested in? *
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Describe in detail what the dog’s lifestyle and living quarters will be like
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Will the dog be (check all that apply)
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Other
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Do you regularly participate in any of the following activities?
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Which and how long (describe other if applicable)
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Is there an adult home during the day?
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If not: How many hours a day will the dog be left unattended and where will it stay?
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Who will care for the dog if you travel or must be out of town?
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Why would you like to adopt an ACD?
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Do you have any prior experience with ACDs? Please Describe
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If this will be your first ACD, how much research have you done on the breed? Tell us what you know about them
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Please tell us you if have an age, color, or sex preference. If you have no preferences please tell us
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Are there any specific habits or problems you are not willing to deal with (describe please)?
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Under what circumstances would you not keep the dog (Divorce, illness, move, etc.)?
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Why should we choose you over other potential adoptees?
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How many dogs have you owned in the last five years and what happened to them? Please give a detailed account (use additional paper if needed)
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References (must list three), please give Names, Addresses, Phone numbers and Email Address if available:
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Veterinarians Name, Address, Phone Number *
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Signature(s) *
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Today's Date
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