Surrender Form

Surrender Form

IMPORTANT NOTE: Completion and submission of this form in NO WAY transfers custody or ownership of any dog to the care of Collie Rescue Network. 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 program, a volunteer will be in touch with your via phone or email. If for any reason your dog is not accepted into the program a volunteer will be in touch with information for possible alternatives including other rescue groups or shelters in your local area who might be better able to assist you. COLLIE RESCUE NETWORK RESERVES THE RIGHT TO REFUSE THE ACCEPTANCE OF ANY DOG, AT ANY TIME, FOR ANY REASON, INTO THEIR RESCUE PROGRAM.
Contact Information:
Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

- Area Code Phone Number
Cell Number

- Area Code Phone Number
Email *
example@example.com
Description of your dog:
Name: *
Age: *
Gender: *
Coat (rough/smooth): *
Microchip:
Date of Birth:
Spayed/Neutered: *
Coat Colour: *
Is this dog a mix: *
If yes, what breeds:
General Information:
Where did you acquire this dog: *
Breeder's Name and Phone Number:
Was the Breeder contacted:
Can the Breeder take the dog back:
How many owners has this dog had in their lifetime: *
Age of the dog when you acquired him: *
Has this dog ever been neglected/abused: *
Is this dog used to being mainly indoors or outdoors: *
How many hours each day is this dog used to be alone: *
When alone, is this dog crated, left loose or left outdoors: *
Is this dog crate trained: *
How often does this dog have potty accidents in the house: *
Does he know basic obedience? If yes, what commands are known: *
Can this dog walk up and down stairs: *
Can this dog walk on linoleum/hardwood: *
Behaviour & Temperament
Is this dog protective? If yes, of whom: *
Does this dog growl at strangers: *
How does this dog react to someone knocking at the door: *
Has this dog ever bitten or caused injury to a person or another animal: *
If yes to above, please provide details here:
Does this dog have any fears (thunder, brushing, etc.): *
Does this dog chase cars: *
Does this dog chase skateboards/bikes, etc.: *
How does this dog react to other dogs or to people approaching when on leashed walks: *
How would you describe your dog (check all that apply): *

Friendly Reserved Laid-back / calm Stubborn High Energy Outgoing Dominant Submissive
Likes & Dislikes:
Check all that apply: *

Likes male dogs Likes female dogs Likes cats Likes children Likes men Likes women Destructive in the house "Barker" indoors or outside Jumps fences Jumps on people Likes car rides Likes being brushed Guards food or treats Takes treats gently Needs a fenced yard Timid with new people Likes toys Likes to chew Other option
Health & Diet History
Date of last vaccinations: *
Date of last rabies shot: *
Date last heartworm tested: *
Heartworm test result: *
Brand of Heartworm preventative used (and when last used): *
Date spayed/neutered: *
Date of last physical exam: *
Name of your veterinarian: *

First Name Last Name
Phone Number of your veterinarian: *

- Area Code Phone Number
What brand of food does your dog like to eat: *
List all past and current medical issues or illnesses: *
Comments:
Additional Information:
Reason for surrendering your dog: *
Comments (please add anything you feel a foster family or the eventual new furever family might need to know):
Should be Empty:

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Surrender Form

Contact Information:

Description of your dog:

General Information:

Behaviour & Temperament

Likes & Dislikes:

Health & Diet History

Additional Information: