Humane Society/Shelter Employee Form

This form is for use by Humane Societies and Animal Shelters who wish to transfer a Border Collie to our care. Please complete the following information to the best of your ability. All information provided is used solely for the purpose determining how we might help the dog you are contacting us about.

*** We cannot process your request without photos. ***

Contact Name:

Email Address:

Phone #:

Facility Name:

Facility Address:

Dog's Name/ID:

Dog's Age:

Gender:

History:

Stray
Owner Relinquishment
Unknown

Arrival date at shelter:

Known background:

Are there any known or reported bite incidents?

Yes No

If so, what were the circumstances?

Reason for relinquishment (if known):

Urgency:

Is there a scheduled euthanasia date if not adopted or rescued?

Yes No

If so, when?

Apparent health status / condition on arrival:

Weight:

Vaccination status:

Will the dog be altered and brought up to date on vaccinations before release?

Yes
No

Is this dog a purebred or a mix?

Purebred Border Collie
Border Collie Mix

If this is a mix, what breed characteristics do you see?

Dog's behavior in run:

Behavior towards other dogs:

Behavior towards people:

What do you know about the dog's behavior around children?

What do you know about the dog's behavior around cats?

Which traits does the dog display?

(Check all that apply)

	Housebroken
	Crate-trained
	Good with children
	Good with other dogs
	Good with cats
	Escape artist
	Friendly
	Affectionate
	Shy
	Assertive
	Dominant
	Treat-motivated
	Likes toys
	Leash-trained
	Food/resource guards
	Scared
	Anxious
	Abused
	Underweight
	Overweight
	Abused
	Bored/Kennel Crazy

Known commands:

Any known fears?

Other comments

If a rescuer does not contact you within one week of your submitting this application, please email our incoming team.