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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
   
                  Name:                                
 Address:                  
     City:  State: Zip:                  
            
                                       Home Phone#:      Cell Phone#:     

SHELTIE INFORMATION
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:   YesNo
All of the answers I have given, are true and correct to the best of my knowledge.
             Signature of owner:         Date:

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Please be patient and do not press the Submit button more than once.
Thank you.