New Mexico Independent Border Collie Rescue Adoption Form

Please download and fill out the adoption contract as well as filling out this form.

• This pet is for: Self Gift Other
• Type of animal desired House Pet Watch Dog Pet for Kids Working Dog
• If working dog, what kind of work?
• Name First Last
• Date / MM / DD YYYY
• Address
  Street Address
  Address Line 2
  City
  State / Province / Region
  Postal / Zip Code
  Afghanistan Albania Algeria Andorra Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Yemen Zambia Zimbabwe Country
• Home Phone - (###) - ### ####
• Work Phone - (###) - ### ####
• Occupation
• Employer
• Employer Phone - (###) - ### ####
• How long have you lived at this address?
• Do you: Own Rent Live With Parent
• Is this a: House Apartment Military Condo Mobile Home Other
• If other, what type of housing?
• If renting, landlord name: First Last
• If renting, landlord phone: - (###) - ### ####
• Have you ever owned a dog? Yes No
• If yes, what breed or breeds?
• How long did you own each dog?
• Are your dogs spayed/neutered? Yes No Some are
• What happened to your pets – where are they now?
• Have you ever adopted from any Border Collie Rescue Organization? Yes No
• If yes, name of your contact at the organization First Last
• If yes, contact's phone at the organization. - (###) - ### ####
• Where will the pet stay during the day?
• Where will the pet stay during the night?
• How many hours/day will the pet be left alone:
• How much do you think it will cost you each month to provide necessary medical care and to cover the costs of feeding and caring for this pet?
• Do you have a fenced yard? Yes No
• If yes, fence type:
• If yes, fence height:
• How will you keep your new companion confined to your property (check all that apply): In house Kennel/run Fenced yard Tie out/chain Garage Patio area Leash Crate Other
• If other, where will you confine your dog?
• Are you aware that pets need regular vaccinations and may require other routine vet care? Yes No
• Do you realize you will probably have to housebreak your new dog? Yes No
• Do you know how to housebreak your new dog? Yes No
• Are there any training issues would you like help with:
• How will you exercise your new companion?
• Do you plan to take your new dog to obedience classes? Yes No
• If going to obedience class, where?
• List all plans for this dog: Pet Guard Herding Obedience Agility Flyball Frisbee Dog Lure Coursing
• Other plans for this dog:
• Do you want to adopt Male Female No preference
• Color preference
• Age preference
• Size preference
• Will you allow your dog to ride in the flatbed or a pickup truck? Yes No
• Are you financially able and willing to provide adequate medical care if the animal becomes sick or injured? Yes No
• Name of vet First Last
• Vet phone - (###) - ### ####
• Do you plan to put an ID collar on this animal? Yes No
• What will happen to this pet if you move?
• Under what circumstances would you not keep this pet? Divorce Move New baby New job Illness Other
• If other, what other circumstances?
• If you go away for a few days, how will you care for your pet?
• Do you travel a lot? Yes No
• Marital Status: Married Single
• Number of adults in household:
• Are all members of your household in agreement with getting this dog? Yes No
• Who will be the primary caregiver for the pet?
• Number of children at home and ages:
• Anyone in Household with allergies or asthma? Yes No
• Elderly or Frail? Yes No
• Who will be responsible for this pet?
• Have you ever surrendered an animal? Yes No
• If yes, why?
• How did you hear about New Mexico Independent Border Collie Rescue?
• Do you understand that pet ownership is a lifetime commitment to provide care and a permanent home for the life of the animal? Yes No
• If for any reason this adoption does not work out you must be willing to return the animal to New Mexico Independent Border Collie Rescue or consult with them on rehoming the animal (you will not receive any monetary refund for returning the animal). Yes No
• I certify the above to be true and that any false information may result in nullifying the adoption -- enter your full name as your signature
• Reference 1 Name First Last
• Reference 1 Phone - (###) - ### ####
• Reference 2 Name First Last
• Reference 2 Phone - (###) - ### ####
• Reference 3 Name First Last
• Reference 3 Phone - (###) - ### ####