Mid-Atlantic Border Collie Rescue

APPLICATION FOR ADOPTION
KEY POINTS TO REMEMBER
1. FEES: A $300.00 donation is required when you adopt a rescue Border Collie. Fees are due at the time of adoption, no exceptions will be made. Some of our dogs require extra medical care or special rehabilitation, which will entail greater expense; we may ask for an additional donation to help cover these extra expenses (this will be noted prior to meeting the dog). Should an adopter wish further exams, tests or x-rays, we are happy to provide these at the expense of the adopter; fees are to be pre-paid and are non-refundable.


2. SPAYING/NEUTERING: Any animal adopted from MABCR will have been spayed or neutered prior to placement.

3. MEDICAL CARE: All dogs brought into rescue receive heartworm test/preventative when called for, as well as rabies, and DHLPP inoculations. All dogs are treated for intestinal parasites and are given a general health screening. NOTE: X-rays, teeth cleanings and other non-emergency medical tests and services are not provided for unless requested by the adopter, and pre-paid for as a donation to rescue. As part of our placement contract, we require that once you have adopted a dog that you take it to your personal vet within the two-week trial period for a well visit. We recommend you follow a regular inoculation program established by your veterinarian to guarantee your dog stays healthy. You will receive a medical history on your Border Collie (as best as can be determined or documented). Be fully aware that most dogs do not come with fully documented medical records. In addition, we require that you have your new dog licensed in accordance with the laws where you live.


4. CONTRACTS: All adopters of rescued animals will be required to sign an Adoption Agreement. This contract is legal and binding. Please read it carefully prior to applying to adopt. We will not alter our contract in order to make placement of a dog.


5. A NOTE ON OUR ADOPTION PROCESS: Since we do not know you personally, the information from the Adoption Application will help us to match you with the right kind of Border Collie for your circumstances. We place Border Collies only into good, loving homes, and we screen prospective adopters thoroughly. Please know that this information is reviewed by a select few volunteers and is never made available anyone not on our Adoption Committee.

Please be sure that you are ready for the commitment it takes to own a dog before you send us this application. Owning a dog or adding another dog to your pack will change your life. We can help you prepare, but we cannot be sure that you are ready, only you can determine that.

If you have applied with other rescue organizations or are considering another breed of dog, please let us know at the time of application, as this will help facilitate the application process with MABCR.

Keep this cover information and the "Terms of Adoption" page for your reference. Please fill out the form below and return it to us via e-mail. By sending us the following application (electronically) you agree to the terms listed within this document.

Please note that we can only accept an application via e-mail.

MABCRs Terms of Adoption

1. Return: The adopted dog may be returned to Mid-Atlantic Border Collie Rescue at any time, for any reason.

2. 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 Mid-Atlantic Border Collie Rescue.
3. 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 Mid-Atlantic Border Collie Rescue.

4. Trial Period: There will be a two-week 'trial' period in which you may return the dog for a full refund of the adoption fee. Within that time it is the adopter's responsibility to contact MABCR to discuss and attempt to resolve any behavioral or health issues that have come to light. We will do our best to help you work through any issues that arise in order to help you keep your newly adopted friend. This trial period is not valid with puppies under 12 months of age unless there are veterinarian-diagnosed health issues with the pup involved. Medical Records must be returned with the pup.

5. Health Program: The adopter agrees to take the dog to his personal veterinarian within the two-week trial period for a general check up. The adopted dog will be cared for humanely, including adequate food, shelter, water and veterinary care and will be licensed in accordance with the laws of the jurisdiction in which he resides. The dog is to be exercised in a fenced yard or on a leash and is not to be free to roam the streets.

6. 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.
7. Loss: If the adopted dog is lost or stolen, the adopter will notify MABCR within 24 hours.

8. Reservation of Rights: Mid-Atlantic Border Collie Rescue reserves the right to enforce this contract in order to protect the welfare of the adopted dog. It is understood that MABCR may examine and may make inquiry about said dog at any time. If the terms and conditions of the Agreement are not upheld, Mid-Atlantic Border Collie Rescue reserves the right to terminate this Agreement and to reclaim the dog.
9. Return check charge: There will be a $40.00 charge on any returned checks

10. During the trial period: the adopter may not 1.) change the dog’s name or 2.) change the dog’s appearance in any way (including trimming or other grooming other than bathing and nail clipping) and 3.) use any type of negative correction including prong collars, electrical correction collars or remote trainers. Use of such equipment or change of the dog’s appearance will result in the loss of the adoption fee as payment for time loss in order to regain the dog’s appearance and/or training in order for the dog to be re-homed.

CONTACT:

Sarah Ruckelshaus,

or 410-778-4669

24420 Chestertown Road Chestertown, MD 21620

www.mabcr.org

Mid-Atlantic Border Collie Rescue Application

(please load this form into Microsoft word, fill out and e-mail it as a word document OR cut and paste into the body of an e-mail and fill out and send. Please be sure to answer all questions. Omitting answers to questions will cause a delay in the adoption process)

Date:

Name:

Partner’s name:
Address:
City:
State:
Zip:
Home Phone:

Cell phone:

Fax number:

E-mail address:

Do you check mail often? _____ (Please check and adjust spam software so e-mails from MABCR volunteers can reach you to begin your adoption process!)
Occupation:

Work phone:

Partner's Occupation:

Work phone:

Cell phone:

e-mail address:

Best way to reach you:

Best time to contact:
Hours spent at home:

Hours spent away from home:

1. Why do you want a Border Collie?

Are there other breeds of dog that you are interested in?______If so, what breeds??

For what purpose do you want to adopt this dog?

How will you provide your new dog with the activity, exercise, and stimulation he needs to be happy?

2. Do you have a sex preference? Male: ______Female: ______No: ______

3. Do you have a preference of: Coat: ______Color: ______

4. Would you consider: The opposite sex? ______a different color/coat?______
A puppy?______An older dog? ______A senior dog? ______

What age range of dog would you prefer to adopt? ______

Would you consider adopting a Border Collie mixed breed? ______

Are you flexible with any of the above options? ______

If so, to what extent? Please elaborate:


5. What size dog do you prefer? (height/pounds)
6. Have you ever owned a Border Collie or a dog from the herding or working breeds before?


7. Do you still have that dog?

What are the qualities that you liked the most about that dog?

And what are the qualities that you liked the least about that dog?

8. Please list past owned pets and what has happened with those pets that they are no longer with you:

Have you lost a pet (not through death)?

Please explain.


9. Have you had a pet poisoned?______

Have you had an animal killed by a vehicle? ______

Would you allow a dog to ride loose in the bed of a truck?______

What are your hobbies?

Are you planning to include your new dog in those hobbies? ___ If so, how? ______
10. Do you presently have any other animals? ______List type, age and sex:

What types of activities do your current dogs enjoy?______


11. Do you have children at home? ______Age(s) ______

if you have no children, are you planning a family in the future?_____


12. Is anyone in your house allergic to animals?______What type of animals?______

13. Do all family adults work? ______Is someone home during the day? ______

14. Are all other members of your household aware that you are considering adopting a dog?______

15. Do you live in a house? ____ Row or Town home_____ Apartment? ____ Condo? ___ Trailer? ____

16. Do you rent or own? ______Are you planning to move in the near future?______


17. If you rent, do you have the landlord's permission to keep a dog? ______

Please enclose a copy of your rental agreement that states you may have a dog. Please Note that this is a requirement for adoption and the adoption application will not be processed without a rental agreement.

18. What provisions will be made for your dog(s) when you are not at home?

Are you familiar with the crate training method?______

Are you willing to crate your new dog when you first bring them to your home?______

Where will your new dog sleep? ______Please elaborate:

What provisions do you have for your dog if you away from home for extended periods of time?

19. Do you intend to keep your new dog primarily indoors or outdoors? ______

When outdoors, how will the dog be contained and will the dog have companionship?

Do you have a yard? _____ Is it fenced? _____ What type of fencing? ______

20. Are you prepared to assume the financial responsibilities of caring for an animal, including

inoculations, veterinarian care, emergency vet care, good quality food, licensing, etc.?______

Are you familiar with Heartworm disease? ______

Are your present (or past) dogs on preventative? ______

21. Are you familiar with the animal regulations in your area? ______

22. Is the dog to be a gift? ____ If so, for whom? ____ Do they know they are getting the gift? ______


23. Do you understand that any rescue dog that you may adopt through Border Collie Rescue will be

spayed/neutered? ______

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

What experience do you have with 'behavioral' problems in dogs?

Do you have access to professional trainer to help with training problems if they arise?

25. Are you willing to allow an MABCR Representative member to visit your home by appointment? ____
26. Do you understand that there will be a $300.00 donation for the adopted dog and that donation will be due on the day of adoption? ______

27. Do you understand and agree that if you ever decide to relinquish the dog that said dog must be returned to Mid-Atlantic Border Collie Rescue at your expense?______

28. Please list name and address and phone number of your family vet.

Name:

Address:

Phone Number:

Contact person:

Please include copies of shot records of all presently owned animals. All animals living inside of the home must be current with Rabies and distemper inoculations (we will accept titers). This is not optional and must include all in-home domestic animals being cared for by the applicant. (ferrets, cats and dogs). If animals are precluded from vaccinations for some reason, we must have that in writing from your veterinarian.

Please e-mail records to us at . Failure to supply veterinary records will delay or prevent your application from being processed.

29. Please list name address and phone numbers of references (at least two non-family members) who are familiar with your lifestyle and ability to take care of animals. Failure to supply references and emergency contacts will delay or prevent your application from being processed.

Name:

Phone number: best time to call:

e-mail address:

Name:

Phone number: best time to call:

e-mail address:

Please list contact information for two people (not the same as above and not otherwise part of the application) who would know how to contact you in the event of an emergency. These contacts may be relatives and may be called as references as well.

Name:

Phone number: best time to call:

e-mail address:

Name:

Phone number: best time to call:

e-mail address:

30. Have you applied with any other rescue leagues or shelters? ___If so, with whom?______

Who is your contact with them?______phone number or e-mail address______

31. How did you hear about Border Collie Rescue?

I am in full agreement with the Border Collie Rescue Terms of Adoption (above). By signing below I am attesting to the truthfulness of my answers. I understand that falsification of any of the above information will be grounds to disallow the adoption of a rescue Border Collie.