Central Illinois Sheltie Rescue Owner Relinquish Form

Date: ______
Owners Name:______Address______
City/State______Phone ______
Reason you are giving up this dog? ______

Dogs Name______DOB: ______Color:______Sex______Altered______
Date of alter:______Dogs Age Now:______Dogs weight?______Microchip______

Does the dog like: Other dogs? ______, Cats? ______, Children? ______Walks ?______Riding in the car?______,
Comments: ______

Is the dog used to living inside a house? ______

Is the dog used to going outside in a: fenced yard?______On a leash ______Loose in yard ______

Please describe the dogs temperament: ______
______
Has this dog ever bitten or tried to bite a human being? ______
Has this dog ever bitten or tried to attack another animal?______
Please give date and details______
Please initial this box ______

Habits:
Housebroken?______

Will signal if needs out? ______How? ______
Any bad habits? ______

Medical History: Last Vet Visit: ______
Veterinarian Name______Phone______
City/State ______

Needs to be On ANY Medication: ______Are you delivering medication along with the dog?______
Items you are sending with Dog: Toys______Food______Collar _____ Leash ______Crate ______Vet Records______
AKC papers ______Donation ______($100 donation is requested, but not mandatory)

It is understood that Central Illinois 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.
Please read, sign and date the following:
I,______, hereby transfer complete ownership of the Sheltie, named ______, to Central Illinois Sheltie Rescue. I am giving this dog to Central Illinois 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 Central Illinois Sheltie Rescue, its board of directors, its 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.

SIGNATURE OF OWNER:______DATE:______

WITNESS ______DATE ______

Central Illinois Sheltie Rescue

Owner Relinquish Form

Please answer the following questions as honestly as you can. We will not refuse your Sheltie based on any negative comments.

When did you get your Sheltie? ______

Where did you get your Sheltie? ______

Is your Sheltie used to living in a home, or in an outside kennel? ______

Has your Sheltie been used for breeding? ______

What food is your Sheltie used to eating? ______

How much do you feed and how often?______

Has your Sheltie been kept on Heartworm Preventative medication? ______

Has your Sheltie been given all its shots every year? ______
Words your Sheltie knows: ______

Things that scare your Sheltie / does not like: (baths, cars rides, storms…) ______

How does your Sheltie react to strangers? ______

Bad habits my Sheltie has: ______

How well housetrained is your Sheltie? ______

My Sheltie WILL snap or bite if : ______

How does your Sheltie get along with other animals? ______

How does your Sheltie get along with small children? ______

My Sheltie is allergic or cannot eat or take the following food or medication: ______

Does your Sheltie have any injuries or illness you want us to check out? ______

Where does your Sheltie sleep at night? ______

Has your Sheltie ever tried to jump or climb a fence? ______
Has your Sheltie ever been abused or hurt by a person? ______
Please list any medication your Sheltie has taken? ______
Any other information we need to know?

Thank you for your honest answers. These answers will help us help your Sheltie