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OWNER
INFORMATION
Please fill out ALL
fields to the best of your ability
Remember, these
questions are necessary to help us place your Sheltie
in the most appropriate home
Home Phone#:
Cell Phone#:
How did you hear about us?:
1. Dogs Name?:
2. Dogs Age?:
3. Color (sable, merle or tri)?:
4.
Is this dog a male or female?: Male
Female
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?: Yes No Sometimes
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?:
50. Tricks?:
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?: Yes
No I don't know
Do you
have any personal comments that you would like to make?
ITEMS
YOU ARE SENDING WITH THE DOG
(SELECT
ALL THAT APPLY)
Toys?:
Food?:
Collar?:
Leash?:
Crate?:
Vet Records?:
AKC Papers?:
Other?:
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.
Please note your donation amount:
Do you
have any other comments you would like to make?
Your
Email Address:
Confirm Email:
Please read, sign and date the
following
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: Yes No
All
of
the
answers I have given, are true and correct to the best of my knowledge.
Signature of owner: Date:
It
may take several seconds to process your application.
Please be
patient and do not
press the Submit button more than once.
Thank you.
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