Collie Rescue of Metro Atlanta, Inc.
Adoption Application
INSTRUCTIONS: In order to speed up the application process, please fill in as much detail as you can. Print and mail to
Collie Rescue of Metro Atlanta, Inc.
Thank you!
Animal's Name/Description: ________________________________________________
Date: ____________________________
Name: _________________________________________ Driver's Lic:_______________________
Street Address: __________________________________ How long at this address?__________
City, State, Zip:
Home Phone: _______________________________ Work Phone:
___________________________
Email Address : _____________________________________________________________________
Where will you be living in 1 year?________________ The Forseeable Future?_________________
Tell us about your home: __Own __ Rent
If you rent, please provide your landlord's name and phone:
_____________________________________________________________________________
What type of dwelling?
__ apartment __ house __ mobile home [park/subdivision/acreage]
__townhouse or duplex
Are you 21 years of age or older? ___ Yes ___ No
Number of persons in your home: _____ Ages of any under 18 years old: ___________________
Your occupation: _____________________________________________________________________
Times usually away from home:
SELF: ______________________________ OTHERS: ____________________________________
Tell us about your pets:
Current Pets:
______________________________________________________________________________
Previous Pets:
______________________________________________________________________________
What happened to the pets that no longer live with you? (check all that apply)
__ left with family __ died of old age/illness __ stolen
__ returned to breeder/previous owner __ ran away __ sold
__ turned in to shelter __ accidental death __ given away
__ other______________________________________________________________________
Have you ever had to treat a pet for an illness or injury? Describe:
______________________________________________________________________________
Have you ever had to put a pet to sleep (euthanasia)? __Yes __No
Have you ever adopted a pet from a shelter/rescue group? Was it a positive experience?
______________________________________________________________________________
Have you ever taken in a stray animal? What happened?
______________________________________________________________________________
Have you ever had a dog that had heartworms? How did that turn out?
______________________________________________________________________________
Who is your veterinarian?
______________________________________________________________________________
May we contact him/her for a reference (if yes, please give phone #, including area code)?
______________________________________________________________________________
Are you able to take the pet to your vet within a week of the adoption IF NECESSARY? Yes_________ ____No
If you have a dog, what kind of heartworm preventative do you use currently?
______________________________________________________________________________
What vaccinations have your pets had?
______________________________________________________________________________
In the event of an emergency, how would you pay for a $500-$1,000 vet bill?
______________________________________________________________________________
What do you expect your annual expenses to be for this pet?
______________________________________________________________________________
What do you know about this breed or species of pet?
______________________________________________________________________________
Who will be responsible for your new pet? __Self __Children __Spouse
Other________________________
Is your family aware of your decision to bring a dog into your home? __Yes __Not yet
Are you willing to commit to a pet for its entire life? __ Yes __No
__Maybe not, but for as long as possible
May CRoMA representatives visit your home in the future to see how the pet is doing?
__Yes __No
What circumstances would cause you to give up this pet?
______________________________________________________________________________
Does anyone in your family have allergies to pets? If so, please describe what you will do to ensure that your new pet is compatible with your family:
______________________________________________________________________________
Are you prepared to crate or otherwise keep your new pet separated from other pets for a few days? __ Yes __ No
Do you understand local vaccination ordinances and leash laws? __Yes __No
Has any member of your family or household ever been charged with cruelty to animals?
__ Yes __ No
Why do you wish to adopt a pet? __companion __ for children __ guard __ gift
other:_________________________________________________________________________
Have you ever taken a pet to obedience school? __No __ Yes -Where?_____________________________________________________________
Where will your new dog spend his time? __house __ garage __yard - describe shelter:_______________________________________________________
Where will your dog sleep? Eat?_________________ Exercise/Play? ______________________
What kind of dog food do you plan to feed? ___________________________________________
What method(s) of flea control do you plan to use? ____________________________________
Describe your fence: __none __chain link __ electric __privacy/wood
other:_________________________________________________________________________
How tall is the fence? __ invisible __ under 4 feet __ 4 to 5 feet __ over 5 feet
Explain why you feel you can provide the best possible home for this animal:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
The above information is correct to the best of my knowledge, which I hereby certify with my signature:
________________________________________
Please be sure you sign here.