Midwest Border Collie Rescue Owner Relinquishment Application

Owner Relinquishment Application

Midwest Border Collie Rescue
See below for the relinquishment form for owners. Please be as specific as possible in describing your dog and reasons for relinquishment.

We would appreciate good photos so we can showcase your dog!

Note that once approved by our relinquishment committee, we will look for an appropriate foster home and if found, the dog will be officially relinquished to Midwest Border Collie Rescue.

Dogs approved by our relinquishment committee are added to our website and your contact email is included. People may contact you to adopt your dog directly.

If your dog is adopted or taken in by another rescue, please email us at team@midwestbordercollierescue.org to let us know.

Thank you!
Owner Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Owner Contact*

First NameLast Name
Dog's Name*
Sex of Dog*

MaleFemale
Dog's Age*
Dog's Height and Weight*
Purebred or Mix*

Purebred with papersPurebred no papersMix
Was this dog purchased from a breeder?

YesNoDon't know
If purchased from a breeder, did you contact them?

YesNo
If purchased from a breeder, why did the breeder refuse to take your dog back?

Not included in breeder contractOut of businessNot purchased from licensed breeder (farm, back yard breeder, etc.)
Why are you relinquishing your dog? Please be specific. *
Has the dog ever bitten? If yes, explain.*
List the dog's general overall health and any issues.*
Dog's history - Check all that apply*

Spayed or neuteredHouse trainedCurrent on RabiesCurrrent on DistemperTested for Heartworm (Negative)Tested for Heartworm (Positive)Not tested for Heartworm
Has the dog met children? If yes, how is it with children (what ages)?*
Has the dog met other dogs? If yes, was the dog on or off leash? What kind of dog was the other dog (size relative to each other, temperament, etc.) How did the dog do?*
The dog reacts in a negative or fearful way to the following (please check all that apply)*

Other dogsStrangersMenWomenChildrenCratesCatsPettingGiving a TreatGuarding FoodTaking away a toyStepping into a dog's spaceDirect eye contactTouching feetTouching tailThunderstormsLoud noisesNone of the above
What commands does the dog know?*

SitStay/WaitOff/Lie DownLeave It/Drop ItNoLoose Leash Walking/HeelNone
Which of the following terms would you use to describe the dog (Check all that apply).*

FriendlyAnxiousShyScaredDefensiveDestructiveAffectionateOutgoingSuspiciousCautiousProtectiveTrainableDifficultStubbornObedientLethargicHyperHappy Go LuckyAnxious to PleaseCalmDrivenQuietFearfulDominant
Please list any behaviors that need improving (I.e. barking, jumping on people, recall, fearful of noises, etc.)*
Please attach pictures of the dogs front end, back tail, right side and left side*

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