MidAmerica Border Collie Rescue - Owner Relinquishment

Midamerica Border Collie Rescue

Owner Relinquishment

Please complete the following information to the best of your ability. All information provided is used solely for the purpose of determining how we might help the dog you are contacting us about.

Steps to finding foster care with MBCR:

Fill out this form completely. ALL INFORMATION IS REQUIRED.

Please send us two photos of your dog:
- We would like a full body shot taken from the side and including the tail.
- A picture of your dog's head, facing the camera.
Fax your dogs medical records, showing spay/neuter, recent negative heartworm test, a negative fecal flotation, current on vaccinations including a rabies, DHPP and bordetella.
Send your photos to: Donna, at dvenner@comcast.net

Send your fax ATTN: Donna to 616-724-4485

Please answer the following questions about the dog needing help:

First Name Last Name

Home Phone Cell Phone Email address

Home Address:

City: State: Zip Code:

Where is the dog located?

Dog's Name Dog's Age Gender

Is the dog spayed or neutered?

Dates & types of Vaccinations

Please give the name & phone # of the vet we can
contact to verify vaccination & health records.

Purebred Border Collie or a mix?

If a mix, what breed does it appear to be mixed with?

Ever bitten anyone?

If so, please give circumstances:

Any Formal Training?

What commands does the dog know?

Is the dog (yes/ no) :

House broken? .... crate trained? .... Leash trained?

Is the dog good with (yes/no): Kids? ... Cats? Other dogs?

What toys/games does the dog like?

Why is it necessary to find a new home for your dog?

MidAmerica Border Collie Rescue is a 501(c)(3) non-profit organization

Steps to finding foster care with MBCR:

Send your photos to: Donna, at dvenner@comcast.net Send your fax ATTN: Donna to 616-724-4485

Send your photos to: Donna, at dvenner@comcast.net

Send your fax ATTN: Donna to 616-724-4485