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Minnesota Wisconsin Collie Rescue 6210 W. State St. Wauwatosa, WI 53213 612-869-0480 (Rescue Line) applications@mwcr.org collietalk@yahoo.com http://www.mwcr.org - Adoption Application Instructions MWCR requires a $25.00 application processing fee, $10 of which will be applied to the adoption fee for a Collie. The remaining $15 is nonrefundable. The application fee is payable to MWCR and helps defray the cost of processing applications. Since MWCR is a non-profit organization, the application fee is tax deductible. This application may be submitted in one of three ways: 1. Let us know via Collietalk@yahoo.com that you would like to FAX the application form, and we will send you the FAX number; and submit the $25 application fee by going to the MWCR Website, clicking on the application form, and selecting PayPal as the method of payment. 2. Download the application form from the MWCR Website, save it to a word processing program, fill out the form, save it, and then send it as an e-mail attachment to collietalk@yahoo.com; submit the application fee according to the instructions in item 1. 3. Mail the application form and a check for the fee to the address noted above. Please note that option 3 is the slowest option, and it is likely to be about a week before we begin processing your application. Please be sure to use adequate postage on your application. Thank you. In order to adopt a Collie from Minnesota Wisconsin Collie Rescue, you must: Complete this adoption application and submit it and the application fee using one of the methods mentioned above. Agree to personal reference checks, a veterinary reference check, and a home visit. Within several days of our receiving this application, you will be contacted by one of our volunteers. Next, a volunteer will call your references, after which a home check will be done. When the process is completed, your application will go to our adoption committee for approval. When your application is approved, we will contact you to suggest one or more Collies that will fit your criteria, family, home, and lifestyle, and then put you in touch with the foster family of one or more Collies you are interested in. At the time of adoption of a Collie from MWCR, a completed and signed adoption contract is required.

Minnesota Wisconsin Collie Rescue 6210 W. State St. Wauwatosa, WI 53213 612-869-0480 (Rescue Line) applications@mwcr.org collietalk@yahoo.com - Adoption Application NOTICE: This form is the property of MWCR and may not be copied, forwarded, or reproduced in any way without the permission of the MWCR board of directors. PLEASE PRINT NEATLY AND LEGIBLY! (Thank you) If you need more space, attach additional pages. Name (Required): Email Address (Required): Street Address (Required): City (Required): State (Required): Zip Code (Required): Home Phone (Required): Work Phone: Cell Phone: Are you employed? Have you applied with other breed rescues or Humane Societies in the last 3 years? If yes, Which Ones: Has your adoption application to any humane society, animal rescue, or other such animal welfare organization ever been rejected? If yes to the above, please describe in detail the reason(s) the application was rejected.

Have you ever been a member of any humane society, animal rescue, or other animal welfare organization? If yes to the above, please list the organizations of which you have been a member, including website URL, contact information, etc. If you have been a member in any humane society, animal rescue, or other animal welfare organization, are you still a member in good standing? t Applicable If not, why not? Please include contact information (website URL, email address, etc) for the organization(s) in question. List the name, age, gender, and breed of all pets you currently own or have owned in the last 3 years: (Required) Were these animals Spayed/Neutered? If no, why not? (Required) Please note: MWCR does not adopt to owners of dogs that are not spayed or neutered except for valid reasons such as showing the dog. Spay/neuter will be verified via the vet reference. What has happened to these animals?: (Required) List all the names and ages of the individuals living in your home including children: (Required) Who is your veterinarian? (Required): What is your veterinarian's phone number? (Required): Are your current pets on heart worm preventative? (Required) t Applicable Do you have a fence? (Required) Partial Invisible type of fence (note MWCR does not consider this type of fencing to be a barrier) Other - Please describe below Description of other type of fencing (Required) Does any member of your household have pet allergies?

May a representative of MWCR come to your home for a home visit for this application? Has a pet of yours ever been taken to Animal Control? Why do you want a Collie? (Required) Would you prefer: Male Female Preference What personality traits do you seek in a Collie? (Required) Do you have experience with a Collie or other herding breed? If yes, explain: Have you ever been through obedience training with a dog? If yes, what method did you learn? What kinds of behavior(s) do you consider unacceptable in a Collie? What would you do to alter this behavior? (Required) Will you accept a Collie with special needs? If yes, which of the following would you accept? Special Medical Needs Abused Behavioral Problems Would you continue to care for a severely ill Collie? t sure How would you discipline a dog? (Required) Color and age preference of Collie: (Required) Sable/White Tricolor (Black) Blue Merle White Any Younger than 1 Young Adult 1-5 Adult 5-8 Senior, Older than 8 What will you do with this Collie if it is not working out: (Required)

Please check all that apply: (Required) I am familiar with crate training I have a fully enclosed fenced in yard or dog run This collie will be kept primarily indoors This collie will be kept primarily outdoors I live in a house I live in an apartment I live in a mobile home I live in a condo I rent (see below) We require a copy of your lease - please send to MWCR with your application If you rent, give the name and phone number of landlord: (Required) Please read all the following and check the boxes to signify your understanding: (Required) I know that Collies shed I know that some Collies may shed a lot! I know that Collies bark I know that some Collies may bark a lot! I know that Collies sometimes herd children, motorcycles, bicycles, trucks, lawnmowers, and other dogs and cats I know that herding can mean chasing, barking, and/or nipping at the heels or backside Please provide 3 references. Do not give as references people who live with you, relatives, or veterinarians listed elsewhere in this application. Reference #1 (Required) Name: Home and Work Phone Numbers (if we may contact them at work): Relationship Reference #2 (Required) Name: Home and Work Phone Numbers (if we may contact them at work): Relationship Reference #3 (Required) Name: Home and Work Phone Numbers (if we may contact them at work): Relationship Please read the following and initial that you have read and understood each point: I understand that: I understand that an adopted dog will have adjustments to make in a new home.

I understand that a Collie that I adopt might need to be re-housebroken due to the move, since changes can be stressful on a Collie. I understand that if I adopt a Collie, it must not be left outdoors unsupervised under any circumstances, left outdoors in an unfenced area even when I am home, or left outdoors even in a fenced situation when I am away from home. I understand that if needed, I would take my adopted dog to obedience classes. I understand that vet checkups are very important! If I adopt a Collie, I will take responsibility for all the necessary vetting during its stay. I understand that an adopted Collie must be on heartworm prevention, and I must have the dog tested for heartworm yearly (or as recommended by my Vet). All MWCR Collies are adopted out only after a negative heartworm test, but we recommend testing again 6 months after adoption. MWCR cannot guarantee the health of any rescue Collie beyond basic veterinary check-ups, vaccines, and heartworm tests. MWCR will disclose any temperament and health information that our foster homes observe regarding any rescued Collie to the best of our ability. Minnesota Wisconsin Collie Rescue has been established to provide for the rescue and adoption of abandoned, neglected, and/or abused Collies. Adopting families acknowledge this purpose of providing a safe, secure, affectionate and healthy environment for the Collie. In order to achieve these goals, please read each of the following items carefully, and initial each to signify you have read, acknowledged, and understood the following: (Required) The adopting family represents that no member of the family has ever been charged with cruelty to animals. The adopting family will keep a Collie as an indoor pet and provide safety, adequate exercise, quality food, water, shelter, necessary veterinary care, and heartworm prevention. The Collie will never be attack or guard trained; used in any aspect of dog/animal fighting; given, leased or sold to anyone other than MWCR; abused or treated cruelly. The adopting family will obtain and keep a current dog license, attach an ID tag to the Collie's collar, and comply with all animal ordinances. The family understands that children and dogs must be carefully observed, that young children should never be left together unsupervised, and that a adopted Collie may be inexperienced in being with children. The family acknowledges that MWCR reserves the right to make unannounced visits to check on the welfare of the adopted Collie and to reclaim the dog if provisions of this contract have been or are being violated. Should it be necessary to litigate in connection with any dispute, the adopting family agrees to pay all court costs and attorney's fees, with actions to be initiated in Hennepin County, MN. I solemnly swear that everything included in this application is the full and complete truth. Collie(s) I am particularly interested in (We cannot guarantee that the dog of your choosing will still be available by the time your application is processed):

Where did you learn about MWCR? (Select all that apply) Adopt-A-Pet Petfinder Pet Expo Fundraiser Internet Search MWCR Member [Give Name] Other [Please describe] Other information you would like us to know Thank you for applying to MWCR for a collie. If you have email, please make sure to add applications@mwcr.org, subject line MWCR to your safe email addresses so that our replies to you are not routed to your spam box. A representative will contact you within 48 hours of receipt of your application. If you do not hear from anyone, please contact us. Thank you for your interest in an MWCR Collie! SIGNATURE(S): Adopting families, by placing their signatures below, signify that they understand the requirements noted above and that the information provided on this form is current and accurate. The families understand that signing this form does not constitute or guarantee adoption of an MWCR Collie. I solemnly swear that everything included in this application is the full and complete truth. Signature Date Signature Date NOTICE: This form is the property of MWCR and may not be copied, forwarded, or reproduced in any way without the permission of the MWCR board of directors.