Collie Rescue of Louisiana, Inc. ~ Adoption Request Form

Navigation

Home
Current Auctions
Adoption Request Form
Our Petfinder Page

Available Dogs

Contacts

Mary Lee Oliphant
102 Affirmed Court
Bush LA 70431
985-875-0071
[email protected]

Susan Pierce
504-861-7571
[email protected]

Website:
[email protected]

This form will be emailed to Collie Rescue LA when you click the submit button.

Name of the Collie you are interested in?:

If you do not have a specific Collie in mind, please fill out the following:

Gender preference?

Would you consider the opposite sex?

Color preference?

Would you consider an older dog?

If YES, what age?

Would you consider littermates or a bonded pair?

What size Collie do you prefer?

Personal Information

First Name

Last Name

Street Address

City

State

Zip

Email

Occupation

Home Phone

Office Phone

Household Information

Are other members of your household aware that you are considering adopting a new pet?

Are you prepared to assume the financial responsibilites of caring for an animal, including yearly veterinary evaluations, vaccinations, quality food, local licensing, etc...?

Number of Adults in your household

Number of Children in your household

Children's Ages range from:

Children's Ages range to:

Dwelling Type:

Do you own or rent?

IF you rent, do you have your landlord's permission to keep a dog?

If you rent please provide the name and telephone number of your landlord or leasing agent:

Do all family adults work?

Is someone home during the day?

Do you have a yard?

If yes, is it fenced?

If fenced, what type of fence?

Pet Information

Do you accept that there will be a $100.00 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 a pet poisoned?

Had a pet killed by a vehicle?

Had a pet die due to disease?

If you answered yes, please identify the disease:

What provisions will be made for your Collie if nobody is home during the day?

Do you intend to keep this dog primarily indoors?

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 local animal control regulations?

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 of Louisiana will be Spayed or Neutered?

What circumstances, in your mind, justify getting rid of a dog?

Are you willing to allow a rescue representative member visit your home by appointment?

How did you hear about Collie Rescue of Louisiana?

If you have any other animals, please list type, age and sex:

Veterinarian Information

Vet's name:

Street:

City:

State:

Zip:

Phone number:

Have a question you'd like to ask?:

Today's date:

Read the agreement paragraph below carefully:

I am in full agreement with the Collie Rescue 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 do 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 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.

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.

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 within three (3) days.

Reservation of Rights: Collie Rescue reserves the right to enforce this contract in order to protect the welfare of the adopted dog. It is understood that Collie Rescue 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 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.

"Thank you for helping!"

Hosted by www.Geocities.ws