Collie Surrender Form
Victorian Collie Rescue
Email address *
Owner's details
Name *
Phone Number *
Email address *
Address *
Animals details
Pets name
Microchip number *
Sex *
Desexed *
Estimated age of date of birth
Reason for surrender
Where did you get your collie from
Does your collie live with other animals. If yes, what other animals
How does your collie usually behave towards the following situations? (please describe)
Timid, excited, cautious, calms quickly, playful, growly, jumpy, will hide, stays away, licks, bossy.
Familiar people
Unfamiliar people
Children under 12
Familiar dog
Unfamiliar dog
Cats
Does your collie see a vet regularly? (once a year)
Clear selection
Does your collie have any past or present medical conditions?
Clear selection
If yes, please describe and list medications.
Does your collies display any of the following behaviours?
Excessive barking?
Clear selection
Destructive behaviours?
Clear selection
Escapes yard?
Clear selection
Surrender declaration *
Required
I am the owner of the above mentioned animal and declare that no other person has any property interest therein. I agree and understand that I am giving up all rights of possession and ownership of the above mentioned animal. I relinquish any claims that I may have on this animal and agree that Victorian Collie Rescue may take any necessary steps in order to re-home this animal. From this day forward I understand that Victorian Collie Rescue do not have to keep in-touch with me about the animal’s progress. I confirm that this animal has not been declared dangerous.

I declare the information I have provided is accurate and truthful, and that Victorian Collie Rescue will not be held liable or chargeable for any false information or misrepresentation that I may have submitted on this form. I further agree and understand that Victorian Collie Rescue will do whatever is necessary for the safety and well-being of this collie.

A copy of your responses will be emailed to the address you provided.
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