Relinquish of Ownership

About You

(PLEASE NOTE: * = required fields)

*Name:

*E-mail:

*Phone:

Address:

City:
State:
Zip:

How did you hear about us? (Internet, Advertisement, Friends):



Sheltie Information

1. Dogs Name?

2. Dogs Age?

3. Color? SableMerleTri

4. Is this dog a male or female? MaleFemale

5. Is this dog spayed/neutered? YesNo

6. How much does the dog weigh (best guess)?

7. Is this dog up-to-date on vaccinations? YesNo


Does the Dog Like...

8. Other dogs? YesNo

9. Cats? YesNo

10. Children? YesNo

11. Strangers? YesNo

12. Going for walks? YesNo

13. Riding in the car? YesNo

14. Does he/she get car sick? YesNo

Do you have any personal comments that you would like to make?


Has the Dog Ever...

15. Lived in your house? YesNo

16. Lived outside? YesNo

17. Been crate trained? YesNo

18. Been allowed to run loose? YesNo

19. Been attacked by another animal? YesNo

20. Been hit by a car? YesNo

21. Allowed to breed? YesNo

22. Been neglected? YesNo

23. Been abused by a person? YesNo

Do you have any personal comments that you would like to make?


Temperament

24. Friendly? YesNo

25. Cautions? YesNo

26. Anxious to please? YesNo

27. Aggressive? YesNo

28. Shy? YesNo

29. Scared? YesNo

30. Loves everyone? YesNo

31. Protective? YesNo

32. Hyper? YesNo

33. Mostly calm? YesNo

34. Trainable? YesNo

35. Will run away if loose? YesNo

36. Dominant personality? YesNo

37. Submissive personality?YesNo

38. Has this dog ever bitten a person? YesNo

If yes, please explain:

39. Has this dog ever bitten another animal? YesNo

If yes, please explain:

Do you have any personal comments that you would like to make?


Habits

40. Housebroken? YesNoSometimes

41. Barks a lot? YesNo

42. Digs? YesNo

43. Escape artist? YesNo

44. Finicky eater? YesNo

45. Jumps fences? YesNo

46. Walks well on a leash? YesNo

47. Chews? YesNo

48. Destructive? YesNo

49. Any other bad habits? YesNo

50. Tricks? YesNo

Do you have any personal comments that you would like to make?


Medical History

51. Do you currently have a Veterinarian? YesNo

Name of Vet:

Vet Phone #:

52. Approx. date of last vet visit?

53. Is the dog on any medications? YesNo

If yes, please list:

54. Is the dog up-to-date on Heartworm Prevention? YesNo

If yes, what brand?:

55. Does this dog have heartworms? YesNoI Don't Know

Do you have any personal comments that you would like to make?

56. Items you are sending with the dog (Select all that apply):
ToysFoodCollarLeashCrateVet RecordsAKC PapersOther


Mid Florida Sheltie Rescue does not buy or pay for dogs. This is a service to help place Shelties in new homes when their present owners can no longer keep them. This service is free, however, a donation to help pay for expenses is appreciated. In no way will this affect our decision or ability to take this dog.

57. Please note your donation amount:


Comments

If you have any other comments you would like to share with us please leave them here:



Your Agreement is Required

I hereby transfer complete ownership of the aboved named Sheltie to Mid Florida Sheltie Rescue. I am giving this dog to Mid Florida Sheltie Rescue knowing that they will place this dog in an adoptive home. I certify that I am the sole, rightful owner of this dog, free and clear of all other interests. I certify that all the information I have given above, is true and complete, and I have not willfully concealed any information about this dog. I hereby forever release, discharge and agree to hold harmless and indemnify Mid Florida Sheltie Rescue, it's board of directors, it's members, officers, and agents from all claims, demands, actions, causes of action, or liability of any kind whatsoever arising as a result of or in connection with the adoption or other disposition of the above named dog.

My name and phone number may be given to the new owner of this dog, so that the new owner may contact me if he/she wishes, to gain any further information on this dog: YesNo

I agree that all of the answers I have given, are true and correct to the best of my knowledge.