BCSAVE - Owner Surrender Questionnaire (Alpha)

Inquiry - Hidden *	Surrender Inquiry
First Name
Last Name
City
Cell Number
Email Address
Why are you surrendering this dog?
When Do You Need to Surrender By? Detail any hard or soft deadlines.
How Long Have You Had This Dog?
Where Did You Get This Dog?
Dog's Name *
Age of the Dog: *	Newborn Puppy Adolescent Young Adult Adult Senior
Breed
Sex:	Female Male Unknown
Weight: Use numbers only.
Spayed/Neutered?	Yes No
Microchipped?	Yes No
Microchip #
Dog Anxieties? Select all that apply...	Commotion Loud Noise Storms Feral (Cannot Be Handled) Semi-Feral (Can be Handled)
Explain:
Behavioral Issues?	Escape Artist Aggression - Boundary Aggression - Crate Aggression - Dog Aggression - Leash Aggression - Kids Aggression - Men Aggression - Strangers Aggression - Women Resource Guarding - Food Resource Guarding - People Bite History - Dog Bite History - Nip/Herding Bite History - Person
Explain:
What Drives this Dog?	Food/Treat Motivated Lap Dog Shadow Dog Herding Toy - Fetch Toy - Tug Dog's Companion Other
Explain:
Cat Tested:	Untested Good Scared Aggressive See Notes
Cage Bird Tested:	Untested Good Obsessive Aggressive See Notes
Chicken Tested:	Untested Good With Free Range Good With Fenced Obsessive Aggressive Chicken Killer See Notes
Sheep/Goat Tested:	Untested Herding Candidate Good Ignores Fearful Loves to Chase Aggressive See Notes
Equine Tested:	Untested Good Ignores Fearful Loves to Chase Aggressive See Notes
Livestock Tested:	Untested Herding Candidate Good Ignores Fearful Loves to Chase Aggressive See Notes
Dog Tested:	Untested A Dog's Dog Playful and Handicaps Well Standoffish but Will Engage Live and Let Live Solo Dog Only See Notes
Puppy Tested:	Untested Playful and Handicaps Well Good Ignores Standoffish Rough See Notes
Senior Dog Tested:	Untested Good Annoying Rough See Notes
Infant Tested:	Untested Protective Curious Afraid / Anxious Aggressive See Notes
Young Children Tested:	Untested Loves Kids Herds - Nip Risk Afraid / Anxious Aggressive See Notes
Older Children Tested:	Untested Loves Kids Herds - Nip Risk Afraid / Anxious Aggressive See Notes
Elderly Tested:	Untested Therapy Dog Candidate Good Bouncy Pushy Bull In China Shop See Notes
At Groomer Tested:	Untested Loves It Easy-Peasy Take-It or Leave-It Anxious Fearful Fights Bite Risk See Notes
At Vet Tested:	Untested Loves It Easy-Peasy Does Fine Anxious Fearful Fights Bite Risk See Notes
At Dog Park Tested:	Untested WEEEEEE!!! Good Times! Hesitant but Warms Up Anxious Fearful Punk Fight Risk See Notes
Travel Tested:	Untested Most Favorite Thing Bouncy & Excited Watches & Naps Good if Distracted Anxious but Ok Anxious & Throws Up Aggressive See Notes
Leash Training:	Untested Perfect Heel Ok Heel Loose Leash Some Pulling Strong Pulling Fights/Alligators See Notes
Recall Training:	Untested Comes on Cue Comes if Not Distracted Comes for Food/Toy Comes When Wants To Aloof / Independent Runs the Other Way See Notes
House Training:	Untested House Trained Indicates to Go Out Dog Door Trained Goes on Demand Occasional Marking Not House Trained See Notes
Crate Training:	Untested Crate Trained Not Crate Trained
Crate Training Notes: Tell us a little bit about the crate training.
Commands & Cues: Describe any trained commands, cues, or tricks.
Additional Notes: Anything else you think will help.
Has the Dog Been to a Veterinarian?	Yes No
Date of Last Rabies Vaccination
Date of Last DHPP/DAPP Vaccination
Date of Last Bordetella Vaccination
Date of Last Heartworm Test
Is the Dog on Heartworm Preventative?	Yes No
Other Medical: Describe any medications, conditions, treatments, or other vaccinations.
Upload pictures of the specified dog. At least one standing profile and one portrait picture of the dog is preferred.
Dog Picture 1
Dog Picture 2
Dog Picture 3

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Border Collie Save & Rescue (BCSAVE) is Texas based all volunteer 501(c)(3) in-home foster based dog rescue dedicated to helping Border Collies and Border Collie mixes.