Collie Rescue Of South Louisiana

Adoption Request


This application will be E-Mailed to Collie Rescue Of Louisiana when all required fields are completed and you click the submit button. Please remember to fill in your name, phone number and/or email address so we can respond to your request.
 
 
Name of the Pet You Are Interested In
   

Or If You Not Have a Specific Pet in Mind, Fill Out the Following Questionnaire
Gender Preference
Color Preference
Second Color Preference
   
Would You Consider The Opposite Sex?
Would You Consider An Older Dog?
  If Yes, To What Age?
Would You Consider Litter Mates Or A Bonded Pair?
   
What Size Collie Do You Prefer?
 

Application Date
 
PERSONAL INFORMATION
   

First Name

Last Name

   

Address

City

   

State

Zip

   
   

E-Mail Id

Occupation

   

Home Phone

Work Phone


HOUSEHOLD  INFORMATION:
Please indicate the following about your household:
   
Are Other Members Of Your Household Aware That You Are Considering Adopting A Pet?
   
Are You Prepared To Assume The Financial Responsibilities Of Caring For An Animal, Including Inoculations, Veterinarian Care, Good Quality Food, Licensing, etc?
   
Number Of Adults:

Number Of Children At Home:

Children's Ages Ranges From:

Children's Ages Ranges To:

 
Dwelling Type

Do you own or rent?

If you rent do you have the landlord's permission to keep a dog?
If Your Renting Please Provide The Name And Telephone Number Of Your Landlord:
      Name:   Phone: 
 
Do All Family Adults Work?
Is Someone Home During The Day?......Explain
   
Do You Have A Yard?
If Yes, Is It Fenced?
If Fenced, What Type Of Fence?
   
Are You Planning To Move In The Near Future?
   
 
Pet Information
Do You Accept That There Will Be A $175.00 Fee For Each Adopted Dog?
   
Have You Ever Owned A Collie Before?

If Yes, Do You Still Have That Dog?
 

 
What Happened To Your Previous Dog?
   
During The Last 2 Years

 
      Have You Lost A Pet (not through death)?
      Had One Poisoned?

      Had An Animal Killed By A Vehicle?
      Had An Animal Die Due To Disease?

          - If Yes, What Did It Die Of?
 

 
What Provisions Will Be Made For Your Collie If Nobody Is Home During The Day?

 
Do You Intend To Keep This Dog Primarily Indoors Or Outdoors?

   
For What Purpose Do You Want This Dog?
   
Where Will It Sleep?
   
Is Anyone In Your House Allergic To Animals?
   
Are You Familiar With The Animal Control Regulations In Your Area?
   
Is This Collie A Gift? 
    If Yes For Whom?
    If Yes Do They Know They Are Getting The Gift?
    Do They Understand That Any Rescue Animal You May Adopt Through Collie Rescue Will Be Spayed/Neutered?
   
What Circumstances In Your Mind, Justify Getting Rid Of A Dog?
   
Are You Willing To Allow A Rescue Representative Member To Visit Your Home By Appointment?
   
How Did You Hear About Collie Rescue??
   
If You Have Any Other Animals Please List Type, Age, And Sex:

   

 

Adoption Request - Veterinary Information

Vet Name:

 Phone Number:

Address:

City:

State: 

Zip:

 

Read the agreement paragraph below carefully:
 

I am in full agreement with Collie Rescue of South Louisiana's terms of adoption. By submitting this form I am attesting to the truthfulness of my answers. I understand falsification of any of the above information will be grounds to disallow the adoption of a rescue Collie.

NOTE:

If you are under 18 years of age, a parent or guardian must approve this application. Thank You for considering a dog from Collie Rescue. If you have any questions, or we can be of any assistance, please don not hesitate to call.

WE RESERVE THE RIGHT TO REFUSE ANY APPLICANT

TERMS OF ADOPTION

Return: The adopted dog may be returned to to Collie Rescue of South Louisiana within two weeks of the adoption for full refund of payment if the adopter is not satisfied with any aspect of the adoption. After two weeks from the above date, no refund will be given even if the dog is returned to Collie Rescue of South Louisiana.

Transfer of Ownership: The adopted dog may not be transferred to any other person for any reason. If the undersigned adopter is forced to relinquish custody of the dog at any time, said dog will be relinquished only to Collie Rescue of South Louisiana.

Refund:  There will be no refund or reimbursement for any expenses incurred by the adopter for the adopted dog, even if it is returned to Collie Rescue.

Health Program: The adopted dog will be cared for humanely, including adequate food, water, shelter, and veterinary care and will be licensed in accordance with the laws in the jurisdiction in which he resides. The dog is to be exercised in a fenced yard or on a leash and NOT TO BE FREE TO ROAM THE STREETS.

Reason for Adoption: The adopted dog is to be kept as a house pet; it shall not be used for medical or any other experimental purpose; it shall not be chained or tied, and it shall not be used for breeding.

Loss:  If the adopted dog is lost or stolen, the adopter will notify Collie Rescue of South Louisiana within three (3) days.

Reservation of Rights:  Collie Rescue of South Louisiana reserves the right to enforce this contract in order to protect the welfare of the adopted dog. It is understood that Collie Rescue of South Louisiana may examine and may make inquiry about said dog at any time. If the terms and conditions of the Adoption Agreement are not upheld, Collie Rescue of South Louisiana reserves the right to terminate the Agreement and to reclaim the dog.

Return Check Charge: There will be a $15.00 charge on all returned checks submitted by the adopter.

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