Date:                

First Name(s):
Last Name(s):

Street address: City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Country: ZIP code:

Phone number: Work phone number:

E-mail address: Occupation(s):

Why do you want a Bearded Collie?

Have you ever owned a Bearded Collie before?

        Yes.     When?                                     
                         Where did you obtain it from? 
                         What happened to the dog?    

        No.

Who is this Beardie for?  Self Spouse child(ren) other

If single, your age:     17-22 23-30 30+

Do you live alone?
  Yes
   No

Do you live with family?
  Yes
   No

If married, do you both work?
  Yes
   No

How many children at home?  Ages? 

Who will be responsible for the Beardie?  Self Spouse child(ren) other

Living situation:  Own Home Rent Home Own Condo / Townehome Rent Condo / Townehome Rent apartment

If renting, does your lease allow pets?
   Yes
   No

Will you be moving within the next year?
   Yes
   No

If moving, when do you plan on it? 

Where will you move to?  

Do you have a yard with a 6 foot fence?
   Yes
   No

Do you have any fencing?
   Yes   Type?    Height?
   No

If you have fencing, is the fence secure and solid?
   Yes
   No

What type of gates do you have? 

Can children open the gates?
   Yes
   No

Do you own acreage?
   Yes
   No

Is the property fenced?
   Yes
   No

Please describe the fencing

Will the dog be fenced or allowed to run loose?  Let loose within a fenced area

What types of improvements are needed in order to provide a secure yard?

When can you make the improvements? 

How long will the improvements take?    

Do you have a pool?
   Yes
   No

If you have a pool, is it fenced?
   Yes
   No

Do you have a dog run?
   Yes
   No

If you have a dog run, is it secure?
   Yes
   No

Have you checked your yard for dangerous articles, plants, or anything the dog might use to climb a fence?
   Yes
   No

Are there any distractions outside your yard which could plague the dog (i.e. a neighbor's dog, loose dogs on street, mischievous children, etc.)?
   Yes
   No

Can strangers gain access to your yard from the street?
   Yes
   No

Are there any allergies to pets in your household?
   Yes
   No

Do you have any other pets?
   Yes    What kind / sex?   
   No

Where did you get your pet?   

How long have you owned your pet?   

If you don't own a pet now, have you ever owned one? 
   Yes
   No

How long did you own them?  

What happened to them?  

If you have other animals, what have been your main problems with them?

If you have other dogs, would you consider them Aggressive Submissive to people?

If you have other dogs, would you consider them Aggressive Submissive to other animals?

If you have other animals (i.e. birds, rabbits, sheep, goats, cattle, horses, etc.), are you prepared to spend the appropriate amount of time required to accustom them and the new dog to each other?
   Yes
   No

Are you willing to take time with the acquisition of this breed, read and learn facts regarding temperament, socialization, proper handling, training requirements, as well as to understand the time required to bring out the full potential of the breed?
   Yes
   No

Have you discussed with your family the pros and cons of owning a Beardie?
   Yes
   No

Have you asked yourself whether or not your lifestyle is so busy that you might not have the time or energy required to properly care for a Beardie?
   Yes
   No

Is your lifestyle such that friends, relatives, and children can gain admittance to your home, property, or car without your supervision?
   Yes
   No

If you have children, are you willing to accept the additional responsibilities of owning a Beardie?
   Yes
   No

Have you taken the time to teach your children the proper way to treat a living animal?
   Yes
   No

Are you aware (and willing to accept) that the dog may not like all of your children's friends, and may need to be kept apart from some of them?
   Yes
   No

Does everyone in the family want a dog?
   Yes
   No

What other breeds have you investigated?

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

Which members are enthusiastic?

Which members are unenthusiastic?

What concerns have been voiced by other family members?

Do you realize that a Beardie typically lives for 10 - 12 years, and that you are committed to care for it for that long?
   Yes
   No

While a Beardie enjoys a daily walk--and if properly conditioned, can go for hikes with you--they may NOT be joggers. Have you and your family carefully considered how the dog would fit into your lifestyle?
   Yes
   No

If you get a young dog, do you understand that early socialization is the key to developing a well-balanced adult Beardie?
   Yes
   No

Do you realize that socialization means taking your dog into crowded areas outside of your home, and having strangers pet the dog?
   Yes
   No

Do you realize that this requirement for socialization starts at about four months of age in a pup's development?
   Yes
   No

Are you willing to expend the proper amount of time and energy to expose your dog to other dogs, people, and children?
   Yes
   No

Are you likely to enroll your dog in basic obedience training?
   Yes
   No

Are you willing to attend obedience classes with the dog?
   Yes
   No

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

Your comments and suggestions are welcomed:

By checking the box next to my name below, I am indicating that I am the person who's name appears at the top of this application. I have answered the questions honestly, and to the best of my ability.

1. Name(s)