Description of collie, herein referred to as "dog":

General History:

Does the dog like the following:   Other Dogs    Cats    Children      Strangers    Car Rides    Walks

Has this dog ever bitten or caused injury to a person or another animal?  Yes No Unknown       If yes, please provide details: 

Is this dog protective?   Yes No Unknown      if Yes, of whom? 

Does the dog growl at strangers? Yes No Unknown        How does this dog react to someone knocking at the door?  

How many owners has this dog had, including the breeder and yourself?  

How often does this dog have a potty accident in the house? 

Is this dog trained in basic obedience?      Yes No Unknown                    Has this dog ever attended formal obedience classes?  Yes No Unknown

Habits of the dog:

Bad habits a dog has are very important for us to know about.  Knowing them prior to coming to rescue helps us to place the dog into an appropriate foster home that can deal with anything the dog may need.  Bad habits to some people are totally acceptable behaviour to others and what is fine in some homes will not be tolerated in others.  Knowing all habits of the dog, including the bad ones, help us find the home that best matches the needs of the dog, therefore we ask you to please be honest for the sake of your dog as well as for the foster home and future forever home your dog will live in.

Please list any bad habits your dog has: 

Temperament of the dog:

Health and Diet History of the dog:

Name and phone number of your veterinarian: 

Date of last vaccinations:         Rabies Tag Number:       Heartworm medication:

What type of food is this dog used to being fed?        What time of day is this dog fed? 

Does this dog have any ongoing medical issues?  Yes No Unknown      if yes, please provide details:

Has this dog had any past illnesses or injuries?  Yes No unknown    If yes, please provide details: 

Other Information:

Reason for surrendering this dog? 

Is there any other information an adoptive family may need to know (fears, dislikes, favourite toys...)?  Please provide as much detail as you possibly can as this will allow us to find the best possible home that meets the individual needs of your dog.

Please provide your full name, address, phone number and e-mail address and someone will contact you in the next few days:

Collie Rescue Network is run by volunteers and therefore it may take a few days before someone contacts you.  If you have questions about this form or about the process of placing your collie into our rescue program please e-mail rescue@collierescuenetwork.com and we will be happy to help you.