| Contact Information |
| First Name: |
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| Last Name: |
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| Address 1: |
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| Address 2: |
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| City: |
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| State: |
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| Zip Code: |
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| Phone Home: |
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| Phone Work: |
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| Phone Cell |
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| Email Address: |
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| General Information |
| Dog's Name |
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| Gender |
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| Spayed or Neutered |
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Reason for surrender
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Maximum Number of characters for this text box is 500.
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| How long have you had this dog? |
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| Dog's Age |
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Dog Date of Birth
(if known) |
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| From where did you originally get the dog? |
Maximum Number of characters for this text box is 50.
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| Is the dog a purebred border collie? |
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| If your dog is a mixed breed, what is it mixed with? |
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| Does the dog have registration papers? |
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| If yes, what registry?
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| Feeding |
| How many times a day is the dog fed? |
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| What type of dog food does the dog regularly eat? |
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| Any known allergies: Is there any food that causes an allergic reaction or that does not “agree” with the dog? |
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| Favorite treats? |
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| Communication and Training |
| Please list the words/terms the dog understands for the following |
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List any other phrases/words the dog will respond to or understands, and explain the meaning of each:
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Maximum Number of characters for this text box is 200.
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| Has the dog had any formal training? |
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| Does the dog know basic commands? |
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| What term or sound do you use for the word NO? |
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| How do you discipline your dog? |
Maximum Number of characters for this text box is 150.
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Does the dog know any tricks?
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Maximum Number of characters for this text box is 200.
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| Living Area |
| Does the dog live in |
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| If the dog lives inside, where does he/she sleep? |
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| Is the dog left inside or outside when owner is at work or away from home? |
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| Doggie door? |
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| If left inside, does dog have access to entire house, or is dog confined to a certain area or rooms? |
Maximum Number of characters for this text box is 50.
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| How many hours a day is the dog alone, on average (no human present)? |
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| Is the dog housebroken? |
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| When the dog is let out/taken out to do it’s business, is dog |
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| Is your dog crate trained? |
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| Exercise and Free Time |
What exercise does dog enjoy?
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Maximum Number of characters for this text box is 200.
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| How do you most often exercise the dog? |
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What type of toys does the dog enjoy/play with?
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Maximum Number of characters for this text box is 100.
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| Hygiene and Handling |
| Is there anywhere the dog does not liked to be touched? |
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Please list dog’s “likes and dislikes” to the best of your knowledge
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Maximum Number of characters for this text box is 300.
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| Is the dog ok with |
| Ears being cleaned |
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| Nails being trimmed |
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| Bathing |
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| Grooming |
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| Water |
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| Does the dog like to swim? |
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| Does the dog get motion sickness? |
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Please describe the temperament of the dog
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Maximum Number of characters for this text box is 300.
0 characters entered. | 300 characters remaining. |
| Please check anything the dog is afraid of (check all that apply) |
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Please list any “bad habits” or behavioral problems the dog has
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Maximum Number of characters for this text box is 300.
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| Is the dog ever aggressive toward people or other animals? |
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If yes, explain
Maximum Number of characters for this text box is 100.
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| Is the dog ok with |
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| Was the dog an only dog or in a multiple dog household? |
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List the age and sex of each of the other dogs in the household, and if they were spayed or neutered
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Maximum Number of characters for this text box is 100.
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| Medical |
| If female, date of last heat |
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| Has the dog ever been bred? |
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| If so, when
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| Has dog ever had puppies? |
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| If so, when
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| Has the dog ever been injured? |
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| If yes, explain
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| Has the dog ever had a serious illness? |
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| If yes, explain
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| Does the dog have any chronic medical conditions, including with vision or hearing? |
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| If yes, explain
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| Any known allergies? |
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| If yes, explain
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| Is the dog current with: yearly vaccines |
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| Date Given
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| Heartworm |
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| Brand and Date Given
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| Rabies |
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| Date Given
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| Name address and telephone of your veterinarian |
Name |
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| Address |
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| Phone |
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| Is your dog currently on any medication? |
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If yes, explain
Maximum Number of characters for this text box is 50.
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| Other |
| Have you emailed photos of your dog to us at photos@azbordercollierescue.com? |
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| I am willing to give a donation to ABCR for assistance in placing my dog |
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| Amount $
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If ABCR cannot take my dog in for re-homing at this time, what will happen to the dog?
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Maximum Number of characters for this text box is 100.
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| I am willing to keep my dog at home until it is adopted and request a courtesy listing on ABCR’s website in order to find a new home for my dog |
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Other Comments
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Maximum Number of characters for this text box is 100.
0 characters entered. | 100 characters remaining. |
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Border Collies 
