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- Home Evaluation -
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Date:___________________


This questionnaire is prepared for your benefit, the prospective owner, and the Collie that you plan to have become a part of your family. Please answer the following questions and return this form at your earliest convenience so that you can be placed on a waiting list for a rescued dog. There are no right or wrong answers, please answer as honestly and completely as possible, so we may match you with a collie that you will be happy with, and who will be happy with you.
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Name:__________ ____________________________________________________________

Address:___________________________________________________________________

City:___________________________________
State & Zip:______________________

Phone:__________Occupations:_______________

___________________________________

1. Why do you want a Collie?____________

___________________________________________________________________________

___________________________________________________________________________

What variety of Collie do you wish? Rough, smooth, any variety?

2. Have you ever owned a Collie before?_______When?______________What variety?________

Where did you get it?__________________________________________

3. What happened to him/her?__________________________________________

4. Who is this Collie for? Self?______For Whom?______________________

5. If single, your age______ Live Alone?______ With Family?______________

6. If married, do you both work?_____Husbands/Wife's Hours_______________

7. How many children at home?_______Ages:_____________________________

8. Who will be responsible for the Collie?_________________________

9. Do you rent?____Own a Home?____Apartment?____Are you moving?_________

10. Does your lease allow pets?____If moving, when_______Where____________

11. Do you have a 6-ft fenced yard?_________Acreage?_______How Much?_______

12. Is the dog to be fenced in or let loose?________________________

13. Do you intend to keep the dog primarily indoors or out? Please

elaborate__________________ __________________________________________________

___________________________________________________________________________

14. Do you have a fence?______Type?___________________Height?_____________

Is the fence secure and solid?____What types of gates?________________

Can children open the gates?__________________________________________

15. What types of improvements are needed to provide a secure yard?_______

___________________________________________________________________________

16. Are you willing to make the improvements?__________________________________________________________________________

17. If you have a pool, is it fenced?_____If you have a dog run is it secure?_______

18. Have you checked the yard for dangerous articles, plants, or anything the dog could use to

climb the fence?_______________________________________

19. Are you aware of any distractions outside your yard that could plague the dog? (Such as

neighbor's dog, loose dogs on street, mischievious children)__________________

20. Can strangers gain access to your yard from the streets?______________

21. Any allergies to pets?________________________________________________

22. Do you have other pets?_____What kind and sex?________________________

23. Where did you get your current/ past pet(s)?____________________________

How long have you had him/her?_______________________________

24. If you don't have a pet now, have you had a pet before?_______________

What kind and sex have you owned before?____________How long did you have him/her/them?_______

What happened to him/her/them?______________________________________

25. If you have/had other animals, what have/has been your main problem with them?

________________________________________

26. If you have other dogs, would you consider them agressive or submissive to other

people?_____________to other animals?____________

27. If you have birds, rabbits, cats, etc., are you prepared to spend the time necessary to accustom them and the dog to each other? _____. Can you isolate the dog from the other animals if they cannot get along?_________

28. Are you willing to take time with the acquisition of a Collie, read and learn all the facts of temperament, socialization, grooming and proper handling and understand the time required to of the breed?______________

29. Have you discussed with your family the pros and cons of owning a Collie?___________

30. Have you asked yourself whether your lifestyle is so busy that you might not have the time or energy to properly care for a dog?______

31. Is your lifestyle such that friends, relatives and children gain admittance to your home, property, and car without your supervision?_______

32. If you have children, are you willing to accept the additional responsibility of a Collie?______________Have you taught your children the proper way to treat a living animal?________________

33. Does everyone in your family want a dog?_____________________________

34. What other breeds have you been contemplating?________________________

___________________________________________________________________________

35. What is your family's overall reaction to owning a dog?______

___________________________________________________________________________

36. Which members are enthusiastic? Unenthusiastic?_______________________

___________________________________________________________________________

37. What concerns have been voiced by other family members?______________

_____________________________________________________

38. Do you realize that a Collie may live for 10-15 years and are you committed
to care for it that long? ___________

39. A Collie enjoys a daily walk, and, if properly conditioned, can go hiking or jogging with you. Have you and your family carefully considered how the dog would fit into your lifestyle?________

40. If you expect to get a young dog, do you understand that early socialization is the key to developing a well-balanced adult Collie? ___________, do you realize that socialization means taking your dog into crowded areas outside of your home and having strangers pet the dog? _________________, that this period starts at about two months of age? _____________. Are you willing to spend this kind of time? ________________

41. Are you likely to enroll your dog in obedience training?____________

42. Are you willing to attend obedience classes to train the dog?_________

Which family members would be expected to assist with home training?_______

___________________________________________________________________________

43. What kind of work or behaviors do you expect of this dog?_____________

___________________________________________________________________________

___________________________________________________________________________
44. Name the most recent dog-training books you have read.

___________________________________________________________________________

___________________________________________________________________________

45. What amount of time and effort do you want to devote to training
him/her?____________________________________________________________________

46. What is your definition of disciplining a dog?________________

__________________________________________What is your initial reaction to the idea of disciplining your dog?_________________________________________

47 What are your training objectives? _________________________

48. Are you interested in showing your Collie? If so, do you have any experience in this area?____________________

49. Are you thinking of breeding your Collie?_______________________

50. Do you plan to spay or neuter your Collie?________________________

51. Do you have a sex preference?______Which?___________________________

52. Would you consider the opposite sex?__________________________________

53. Would you be interested in an older dog?______________________________

54. Would you be interested in a rescued dog?_____________________________

55. Would you be interested in a young adult/older puppy?_________________

56. Are you agreeable to returning the dog, should some unforeseen circumstance arise wherin you would no

longer be able to keep the dog?_____

57. Would you be willing to allow us to visit your home?_______________

58. How did you find out about us?____________________________________

59. Your comments and suggestions:________________________________________

____________________________________________________________________________

____________________________________________________________________________

60. Color, sex and age preference in a Collie:_______________________________

Please list 3 references, name, address and phone number and relation, your vet may be one of them::

1._______________________________________

2._______________________________________

3.______________________________________



Your Signature:_____________________________________Date:__________________

Thank you for your cooperation. This comprehensive questionnaire helps us in placing the right dog with the right family. An improper placement, or one in which all the details aren't known can end tragically, usually for the dog. Again thank you.