REIGN & HAIL SHELTIE RESCUE  

Owners Name:___________________________________ Date of surrender ____________________
Address_________________________________________
City/State______________________________   Phone  _______________________

Reason you are giving up this dog? ______________________________________________________
____________________________________________________________________________________
Dogs Name_______________________ DOB: ________Color:_______________ Sex____Altered______
Date of alter:_____________   Dogs Age Now:______________   Dogs weight?_______________
Does the dog like: Other dogs? ________, Cats? _______, Children? _________Walks ?_______Riding in the car?__________, Comments:___________________________________________________________________
How did you aquire your sheltie?  _________________________________________________________
____________________________________________________________________________________
How long have you had this sheltie?_______________________________________________________

Is the dog used to living in a house? _________     
Is the dog used to going outside in a:    fenced yard?______    On a leash __________   
                                                                 Loose in yard ____________
 How did you acquire this dog and how long have you had it?_____________________________________
_____________________________________________________________________________________
Please describe the dogs temperament, tricks habits, routine___________________________________
__________________________________________________________________________________________________________________________________________________________________________
_____________________________________________________________________________________

Has this dog ever bitten or tried to bite a human being? _____________________________________________________
Has this dog ever bitten or tried to attack another animal?________________
Please give date and details____________________________________________________________
Please initial this box (acknowledging the above statement)____________________

Habits:
Housebroken?________    Will signal if needs out? ___________ How? ____________________ 
Any bad habits?_________________________________________________________________
 
Medical History:   Last Vet Visit: ____________________________________
Veterinarian Name_______________________________ Phone_________________
City/State _______________________________________________________________
Needs to be On ANY Medication: ______Are you delivering medication along with the dog?_________
Copies of vet records supplied to rescue?_____________
Current Rabies?_______________Current Distermper?____________Heartworm tested? Neg ?_________
Currently on any heartworm preventative?________ What brand?______________

Items you are sending with Dog: Toys______ Food (kind fed)______ Collar _____ Leash ______Crates_______  
AKC papers __________   
Schedule/routine - feeding - potty- etc__________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________


Donation $____________________
It is understood that Reign & Hail 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 Reign & Hail Sheltie Rescue. I am giving this dog to Reign & Hail 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 Reign & Hail 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.

SIGNATURE OF OWNER:_______________________DATE:__________________
WITNESS:______________________________________DATE _______________ 
Please sign at transfer of dog to rescue and the witness being the one you are transferring to.