First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Home Phone

Work Phone
x

Cell Phone*

Dog's Name*

Age*

Sex*
Choose one: Male Female

How long have you owned your sheltie?*

Spay or Neutered

Breed/Color

Micro chip type/Tattoo/Distinguishing Marks

Housebroken?

Crate Trained?

Obedience Trained

Brand of Food

Has the dog ever bitten anyone?

Does the dog have a gender preference?

Is the dog good with

The reason you are releasing the dog*

Your vet's name and phone #

Any known health issues?

On any medications

Is your pet current on their vaccinations, date of vaccinations?

Is your pet on Flea or Heartworm prevention, date last given?

Will you take the dog back if it does not work out in rescue?

I (state name) *

hereby release and relinquish all claim to the dog described above and I acknowledge that I have read and understand the Release and information I provided is accurate and true to the best of my knowledge. I also understand that if I change my mind and want my dog back and the dog has not been adopted and we agree to return the dog, I will be required to pay all expenses of provided vet care, medication and a boarding fee of not less than $5.00 per day and not more than $10.00 per day, depending on services provided. We do reserve the right to not return the dog in any circumstance.