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 ________________