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Mo-Kan Border Collie Rescue
Ownership Release Agreement

I,____________________________________, hereby donate to Mo-Kan Border Collie Rescue the Border Collie known as __________________________________. Age ___________.

I hereby turn over full ownership and responsibility as of this date:
____________________, 20_____.

I understand that with this instrument the dog becomes the property of Mo-Kan Border Collie Rescue. A relinquishment fee of $25.00 plus necessary medical fees if the dog is not spayed/neutered or up to date on vaccinations and heartworm preventative.

____________________________________
Witness

____________________________________
Witness


____________________________________
Signature of Owner

Address:

____________________________________
____________________________________
____________________________________

Telephone:
____________________________________


PLEASE FILL OUT THE FOLLOWING SECTION
(Yes or No where applicable)


Does the Dog Like:
Other dogs________, Cats________, Children________, Walks________, Riding in the Car________, Strangers________, Water________, Play________, Other________________

Has the Dog Been:
Tied________, Chained________, Loose________, Beaten________, Housedog________, Kenneled________, Doghouse________, Loose in Yard________, Yard at all times________, Yard part-time________, Other________________


Habits:
Housebroken________, Howling________, Runs________, Barking________, Finicky eater________, Signals to go out________, What signal?____________________________________
Used to collar and leash________, Walks nicely on leash________, Digging________, Escape artist________, Gets out to follow children________, Jumps on people________, Jumps fences________, Chewing________, Destructive________, Vindictive________, Gulps food________

Tricks________________________
Training________________________
Titles________________________
Other________________________

Temperament:
Friendly________, Enthusiastic________, Outgoing________, Suspicious________, Cautious________, Anxious to please________, Happy-go-lucky________, Aggressive________, Shy________, Protective________, Very trainable/obedient________, Hyper________, Untrainable________, Calm________, Adaptable________, Reserved________, Stubborn________, Lethargic________, Inflexible________


Can you add anything to describe the dog's general temperament?

Has the dog ever bitten a person? Yes________ No________

Explain:

Action taken:

Physical Appearance:
Color______________Weight_________Height at withers________

Medical History (skip if medical records are available):
Veterinarian ________________________________
Address________________________________
______________________________________
______________________________________
Phone__________________________________
Spayed or Neutered:________________ Date:______________________
Rabies Vaccination:________Date:__________________Expires:_______________
Other shots and dates:_________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Allergies:______________________________________
Medicine______________________________
Deworming:_________________________________Date_________________

Please answer the following even if med records are available:
Is this dog on heartworm preventative________
If so, what brand and dose? ________________________________________
Registration papers? ________
Association and number ___________________________________________

Food and Medication:
Type of food________________ Number of feedings per day________________ Amount________________
Type of medication________________ Dose________________


Reason for giving dog up:

Items received with Border Collie:
Donation________ Amount________ Leash________ Collar________ Toys________ Blanket________ Crate________ Food________


(For use by Rescue)

Volunteer's Name________________________ Phone________________
Dog Taken To ________________________ Phone ________________
Address ________________________________________________
________________________________________________________
________________________________________________________
Date ________ Rescue Number________ Date adopted________________
Papers?________________
New owner ______________________________________________
Address ________________________________________________
________________________________________________________
________________________________________________________
Phone ________________

 

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