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Owner Relinquishment Form

Must be submitted by owner before we will accept the dog into our program. Please be sure you are serious about relinquishing your dog before involving the program's time and energies.

Thank you for entrusting your precious Sheltie to our rescue program so that he or she may have a new life. We realize there are many good reasons for relinquishment and respect those decisions. Giving your dog this opportunity is an act of love, and you are definitely doing the right thing. Some owners fear that we will put down their dogs when they come into rescue. Please rest assured: we are a dedicated "no kill" rescue program for Shelties who need us, and we love all our dogs. Our mission is to care for your dog, and find him or her the best family possible for a great match. However, Houston Sheltie Rescue will not accept dogs who are aggressive with other animals or with people. If we discover a dog relinquished to us attacks others, that dog will be returned to the original owner.

I, , certify that I am the sole and legal owner of this Sheltie and hereby surrender to Houston Sheltie Rescue, Inc. Rescue Program the Sheltie known as . I hereby turn over full ownership and responsibility as of this date: . I understand that the contract is effective immediately from this date. I also understand that with this instrument the dog becomes the property of Houston Sheltie Rescue, Inc. Rescue Program. I will make no attempt to reclaim or visit this dog. I understand there will be no further contact with HSR or with the adoptive home, and that I can see how my dog is doing on the HSR web site. I am donating $ towards the care and placement of my Sheltie.

Witness ______________________________	Signature of Owner______________________________
Address of Owner	Telephone Number of Owner
Your email:

Release of Veterinary Records

Owner's Clinic

I hereby authorize the veterinarian named herein to release information about me or my pet(s) to Houston Sheltie Rescue, Inc. as necessary to evaluate this application.

PLEASE FILL OUT THE FOLLOWING SECTION TO HELP US PLACE YOUR DOG

(Check all that apply; add any helpful information where you can.)

Socialization:

Does the Dog Like:
Other dogs?	Cats?	Children?
Walks	Riding in the car?	Strangers?
Play?	Other?

Has the Dog Been:
Housedog?	Crated?	Chained?	Loose in neighborhood?
Doghouse?	Loose in yard?	Yard at all times?	Yard part-time?
Other?

Habits

House trained?	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?
Training?		Tricks?
Other?		Titles?

Temperament

Friendly?	Enthusiastic?	Anxious to please?	Happy-go-lucky?
Suspicious?	Cautious?	Aggressive?	Shy?
Reserved?	Protective?	Very trainable/Obedient?	Hyper?
Untrainable?	Calm?	Adaptable?	Stubborn?
Lethargic?	Inflexible?

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

Has the dog ever bitten a person? Yes No
If Yes, explain:

Action taken?

Physical Appearance


Color:	Size:	Age:

Medical History


Veterinarian:
Address:	Phone:
Shots (Which?)	When?

Rabies Shot?			Date:			By:			Expires:
Heartworm test?			Date:			Positive Negative

Is this dog on heartworm preventative? Yes No			If so, dose/brand:
Fecal exam date:			Results:
Spayed? Neutered?			Date:
AKC papers? Yes No			Number:
Other medical history (illness, allergies, injuries, physical problems):

Food and Medication


Type of food:	Number of feedings per day?	Amount:
Type of Medication:	Dose:	Reason for giving up dog:

Items given with Sheltie


Leash?	Collar?	Toys?	Describe Toys:
Blanket?	Crate?	Food?	Describe Food:
Other?

*Code:

(Please click on the Submit button only once.)