Patriot Hill Farm, Jana Brady

605 Mt. Olivet Church Road

Elkton, VA 22827

         The information below will help us determine if we have a puppy that will meet your needs and desires.  This application was intended to solicit brief replies but feel free to elaborate on any part of this form that you like.  When completed, please send this Application, the Puppy Contract and the quoted deposit to me at the above address.  The individual who will be the buyer/handler/care-giver to the puppy must fill out the application.   Please note:  We do not place puppies as gifts to a third-party under any circumstance.  You must be 18 years or older to apply for a Patriot puppy.  Receipt of your application does not guarantee a puppy placement.


Street Address:
City, State, ZIP CODE:
Day Telephone:                                                        Evening Telephone:
How long have you lived at the above address?
 Please summarize your  previous experience with dogs including any Border Collies you may have owned, trained and or shown (titles earned):  (Please include any dog fancy clubs you are a current member of).



Please list all children under 18  and age that will be living with this puppy:


Please list and describe all other animals that will be living with this puppy on your premises:



Please describe your ideal puppy:  (Gender preference, physical characteristics, coat color and length, temperament preferences, etc.) 

Please list all available puppies on our website in your order of preference.




What are your goals for this puppy? (Companion pet,  performance (describe what type activity (ies) you would like to pursue with this puppy, ie, herding/working, obedience, agility, tracking, search and rescue, etc), conformation, or other:



Describe your techniques that you intend to use for training your puppy?



What other information would you like me to consider in matching a puppy to your needs?



Please list 3 references with current phone numbers who are not family members that know of your ability to care for this puppy including at least one veterinarian.



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Signature of Applicant                                                                Date