Relinquish of Ownership

 

New England Sheltie Rescue

 

NEW ENGLAND SHELTIE RESCUE

DOG RELINQUISHMENT FORM

I ____________________ on this day _____/_____/_____/ relinquish ownership to the Shetland Sheepdog Known as ____________ AKC#______________ to the New England Sheltie Rescue, with the exception of any and all summons, law suits, and damages caused by the above mentioned dog. I also agree to release any and all paper-work pertaining to the above mentioned dog, (health records, AKC. papers etc.) to the New England Sheltie Rescue. To help with the adoption process I agree to fill out this questionnaire to the best of my knowledge.

NAME________________________________ADDRESS_________________________

CITY____________________________STATE_____________ZIPCODE__________

PHONE # (_______)______________ DRIVERSLICENCE#____________________________

SIGNED___________________________________ DATE________/_______/_______

Please explain why you are giving up ownership of this dog.

 ___________________________________________________________________________

___________________________________________________________________________

  1. Has this dog ever bitten anyone? Y N If yes please explain.
  2. Is this dog up to date on all of it’s shots? Y N
  3. Date of last worming? _____/______/______
  4. Date of the last heart worm check? _____/_____/_____ . What were the results ? Positive or Negative
  5. Has this dog ever had Lymes Disease? Y N
  6. Does this dog have any medical problems? Y N If yes please explain what they are and what course of treatment is being used to correct the problem.
  7. Has this dog had any formal obedience training? Y N
  8. What type and how much dog food is this dog being fed?_______________________________
  9. Has this dog ever been bred or used for stud service? Y N Is this dog spayed/neutered? Y N
  10. Where did you get this dog from? (Pet store, breeder, shelter, etc.) name of breeder or pet store also include the address.________________________________________________________________
  11. How long have you owned this dog?_________________________________________________
  12. Where is this normally kept?________________________________________________________
  13. When outside how is this dog confined? Walked on a leash, cable run, kennel, or allowed to roam.
  14. When indoors how and where is this dog kept? Free run of the house, confined to a room, crated up or tied up.
  15. Where does this dog sleep at night?____________________________________________________
  16. Is this dog destructive when left alone? Y N If yes will it chew-up objects on the floor, chew furniture, carpets or flooring, door frames or wood work? Please circle all that apply.
  17. Has this dog ever lived with children? Y N If yes what ages__________________________
  18. Has this dog ever shown aggression towards children, men, women, strangers? Y N if yes please explain.
  19. Does this dog play rough or show aggression towards other animals? Y N if yes please explain.______________________________________________________________
  20. How does this dog act when riding in a car?_____________________________________________
  21. Has this dog been bathed and or groomed regularly? Y N
  22. How does this dog react when you have strangers come to your home? Aggressive, barks a lot, runs away, jumps on them, could care less? Circle all that apply.
  23. Have you tried to find a home on your own for this dog? Y N
  24. Name and address of the veterinarian that takes care of this dog.________________________________________________________________
  25. How did you hear about New England Sheltie Rescue? _____________________________________
  26. Any other information that could help place this dog (likes or dislikes etc.).
  27. What is the age of this dog? ______ yrs. ____mo.
  28. Is this dog house broken? Y N

 

 

 

 

Southland Sheltie Rescue 

SOUTHLAND SHELTIE RESCUE, INC.

OWNERSHIP RELEASE FORM

I, ________________, hereby donate to Southland Sheltie Rescue Inc., the following dog known as: ________________, age_________ sex _____________. I swear, on penalty of perjury, that I am the legal owner of this dog and have the authority to transfer ownership to Southland Sheltie Rescue, Inc.. I understand that with this instrument the dog becomes the property of Southland Sheltie Rescue, Inc. as of I am donating $___________ towards the placement of my Sheltie.

___________________________________            _________________________________

    SIGNATURE OF LEGAL OWNER                                    ADDRESS

____________________________________              _________________________________

                 CITY                                                                               STATE, IL

Telephone Home:__________________________

Telephone Work: __________________________

Witness:  ________________________________________

 

INFORMATION ON THE DOG:

MEDICAL: SPAYED or NEUTERED DATE: RABIES SHOT DATE: EXP. (CIRCLE ONE)

OTHER SHOTS: DHLPP BORDATELLA CORONA OTHER ALLERGIES: MEDICINE WORMING DATE

DOGS LIKES: Water : Children : Cats : Strangers : Other Dogs : Play : Ride in Car : Other :

HABITS: Housebroken Signal to go out: Jumps Fence :

Digging: Chews Furniture: Other :

TRAINING: Degrees: Tricks:

TEMPERAMENT: Outgoing: Friendly: Shy:

Please describe the dog's general temperament:

 

 

HAS HE/SHE EVER BITTEN ANYONE? EXPLAIN: Use other side if necessary…More to fill out on other side.

ADDITIONAL INFORMATION:

REASON FOR GIVING UP THIS DOG: ______________________________________________________

___________________________________________________________________________

ITEMS RECEIVED WITH SHELTIE: Donation Amount Leash Collar Toys Blanket Crate Food Other: VOLUNTEER'S NAME: ______________________PHONE: __________________________

ADDRESS: ________________________   DATE: ____________________________

DOG TAKEN TO: _____________________________________

APPROXIMATELY:

1. HOW TALL IS YOUR SHELTIE? ( USING A YARDSTICK, THE AVERAGE SHELTIE STANDS 14" TO 16"

AT THE SHOULDERS. MEASURING HIM / HER FROM THE FEET TO THE TOP OF HIS / HER BACK)

 

2. HOW MUCH DOES HE / SHE WEIGH?

 3. WHAT COLOR IS HE / SHE? CIRCLE ONE:

SABLE: Brown, White                 TRI : Black, Tan, White             MERLE: Gray, Black, Tan, White

OTHER Color: PLEASE EXPLAIN?

 

4. ARE THERE ANY MEDICAL PROBLEMS WE NEED TO BE AWARE OF?

(IF SO PLEASE EXPLAIN BELOW)

5. IF POSSIBLE PLEASE SEND A PHOTO OF YOUR SHELTIE.

THANK YOU.

 

Central Illinois Sheltie Rescue

Central Illinois Sheltie Rescue

Relinquish of Ownership Form

 

Owners Name: ___________________________________________Address___________________________

City/State__________________________________________ Phone(s) _____________________________________________________

Date:_______________ Dogs Name_______________________ DOB: ________________ Color:________________ Sex______ Altered: ____________ Date of Alter:_____________ Dogs Age Now:______________

Does the dog like: Other dogs? ________, Cats? _______, Children? _________Walks ?_______Riding in the car?__________, Car sick? __________ Strangers? ___________, Water (i.e.…lakes,ponds)? _____________Playing? _____________, Other?________ Comments: _____________________________________________________________________________________

Has the Dog ever been: House dog? _________ Kenneled?________, Doghouse?__________Tied? _________, Chained? ______, Allowed to run loose?______________ In fenced yard?_____________, What % of day? _________________, Abused by a person?________________ Neglected? _________, Attacked by other animal? ________, Hit by car?___________Allowed to breed? _______________,Comments:____________________________________________________________________________

The Dogs Temperament: Friendly?_______, Cautious? ______, Anxious to please?_________Aggressive? _______, Shy?______, Afraid of People?____________Reserved? ________ Scared? _______ Confident? ______ Outgoing?_________Loves everyone?___________ Protective?_________, Obedient?__________, Hyper?___________Calm?______, Trainable?_________, Stays nearby if loose? _____________ Will run away if loose? ____________________, Loves other dogs? ___________Dominant? __________________ Submissive? _______________Good with children?___________Used to being around small children?___________, Used to being around other dogs? _________ Used to being around cats? _____________, ANY Dislikes: _______________________________________

Has this Dog ever bitten a person? _____________________________another animal?___________________________

If yes, please give date and details:_________________________________________________________________

_______________________________________________________________________________________________

Action Taken: _______________________________________________________________________________________

Habits: Housebroken?________ Always____ Sometimes_____ Not at all_________ Explain: _____________Will signal if needs out? ___________ How? ________________________________________________________Howls? _______ Cries at night? ________ Barks? ________________ Finicky eater?__________ Walks on lead? __________ Used to wearing a collar? _________Digs?__________ Escape artist?___________  Jumps fences? _____________ Will walk off with anyone? ____________ Chews? ___________ Destructive?___________ Any other bad habits?____________________Tricks? _____________________ Words dog knows?__________________________________ Titles or Awards:____________________________________

Medical History: Last Vet Visit: _________________________Veterinarian Name ____________________________                   Phone ____________________City/State_________________________________________________________Heartworm Test Given:_________ Date:______________ Heartworm Preventative Given? _______Allergic to Anything? ___________________   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 $______________________

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. This service is free, however a donation to help pay for expenses is appreciated.

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.

I agree / do not agree to allow my name and phone number to be given to the new owner of this dog, so that the new owner may contact me if he wishes, to gain any further information on this dog.

SIGNATURE OF OWNER:___________________________________________ DATE:________________________________

WITNESS _____________________________________________ DATE _________________

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