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Collie Rescue Network:

Owner Release & Surrender Form

Please fill this form out entirely and honestly. Please remember that your Collie will be living in a foster home, with real people. Saying your dog is wonderful with children when in reality he only tolerates them for short periods has the potential to put any possible children in a foster home at risk if you are not honest on this form. We have foster homes able and ready to deal with just about any medical or behavioural issue your Collie may have but we need the information from you on what those issues might be in order to place him into the foster home that best matches his needs. Please be truthful when providing the information below regarding your Collie's habits, likes, dislike, medical and/or behavioural issues.

Description of dog:

Call Name of dog:		Registered Name:
Tattoo Number:		Microchip Number:
Gender:		Spayed/Neutered:
Age:		Date of Birth:
Coat Type:		Coat Colour:

General History:

Breeder's Name and Phone Number:

Was the breeder contacted?		Does the breeder want the dog back?
Has this dog ever been abused?		How many owners, including you, has the dog had?
Is he mainly indoors or outdoors?		How many hours does he spend alone each day?
Is this dog protective?		<----- If yes, of whom?
Does he growl at strangers?		How does he react to someone knocking on the door?
Does he know basic obedience?		What commands does he know?
Is he okay with hardwood flooring?		Can he do stairs without difficulty?

Has this dog ever bitten or caused injury to a person or another animal?		<------ If yes, please provide details:
How often does he have potty accidents in the house?		Is this dog crate trained or has he ever been crated before?

Likes/Dislikes and Habits of the dog:

Likes Male Dogs	Likes Female Dogs	Likes Men	Likes Women	Likes Cats
Likes Kids under 5	Likes older kids	Likes Walks	Likes Toys	Likes Car Rides
Used to wearing a collar	Walks well on leash	Follows Children Around	Digs in the yard	Jumps fences
Barks when left alone	Destructive in the house	Jumps up on people	Prone to barking	Snaps when taking treats
Guards food from people	Guards food from other animals	Guards toys/possessions from people	Guards toys/possessions from other animals	Good off-leash

Other (list any other habits, likes or dislikes):

Temperament of the dog (please check off all that apply):

Friendly	Anxious to please	Very trainable	Obedient
Happy-go-lucky	Hyper	Outgoing	High-energy
Reserved	Untrainable	Calm	Stubborn
Lethargic	Laid back	Timid	Reserved/Cautious

Health and Diet History of the dog:

Vaccinated?	Yes No	Date:	Next Due:
Rabies Vaccination:	Yes No	Date:	Tag #:
Heartworm tested:	Yes No	Date:	Results:
Heartworm Medication:	Type:	Date last given:	Dose:

Name and phone number of your veterinarian:

What type of food is this dog used to being fed?		What time of day is this dog normally fed?
Does this dog have any on-going medical issues?		If yes, please describe:
Has this dog had any past illnesses or injuries?		If yes, please describe:

Other Information:

Reason for surrendering this dog to rescue:

Is there any additional information a future adoptive family or the immediate foster family may need to know (fears, likes, dislikes, favourite toys or games....)? Please provide as much detail as possible as this information will help us find the best possible match in a home that meets the individual needs of your dog.

Surrendering Person(s):

Full Name:		Home Phone:
Address:		Cell Phone:
City, Province, PC:		Email:

Important: Filling in this form in no way transfers custody or ownership of the dog to the care of Collie Rescue Network and in no way guarantees your dog's acceptance into our rescue program. The purpose of this form is for informational purposes only and to help CRN use the information given here to determine if we are able to accept your dog into the rescue program. If your dog is accepted into the rescue program a volunteer from CRN will contact you at the phone number or email you have listed above. If we can not accept your dog into the rescue program a volunteer will contact you and provide information for alternatives including shelters in your area and/or other rescue groups who may be able to help. Collie Rescue Network retains the right to refuse the acceptance of any dog at any time for any reason into it's rescue program. If your dog is accepted into the rescue program, a copy of this form will be given to you to sign and date on the day the dog officially enters the rescue program.