Request to Relinquish Ownership

BLUE RIDGE BORDER COLLIE RESCUE
Request to Relinquish Ownership

If you are faced with the difficult decision to give up your Border Collie, please fill out the form below, and a volunteer will contact you to see how BRBCR may be able to help. We are only able to consider dogs within VA, WV, MD, PA, and Washington DC, who are close to one of our volunteers’ location due to the fact that we conduct an in-person evaluation prior to accepting an owner relinquishment.

PLEASE PROVIDE INFORMATION ABOUT YOU

Your Name: *

First

Last

Select Your Age: *

• Under 21
• 21 – 50
• 51 – 70
• Over 70

Your Address: *

City: *

State: *Select OneVAWVMDPADCNC

BRBCR can only consider dogs within our volunteers’ locations.

Zip Code: *

Phone#: *

Email Address: *

---

YOUR DOG'S INFORMATION

Dog's Name: *

Breed: *

Age: *

Microchip #:

Gender: *

Spayed/Neutered? *

• Yes
• No

Weight: *

Body Score:

Selected Value: 5

1=Extremely Under Weight / 5=Ideal Weight / 10=Obese

How long have you had your dog? *

Where did your dog come from? *

Is your dog current on the following: *

• Rabies Vaccination
• DA2PP
• Flea/tick preventative
• Heartworm preventative

Describe Any Health Issues: *

Describe Any Behavior Issues: *

Indicate all that apply to your dog:

• Crate-trained
• House-trained
• Leash-trained
• Rides well in car
• Kid-friendly
• Men-friendly
• Women-friendly
• Stranger-friendly
• Dog-friendly
• Cat-friendly
• Small animal-friendly
• Livestock-friendly
• Indoor only
• Mostly indoor
• Outdoor only
• Mostly outdoor
• Separation Anxiety
• Noise Reactive
• Motion Reactive
• On Medication
• Resource Guarding
• Food Aggressive
• Toy Aggressive
• Dog Aggressive
• Nips/Herds
• Air-Snaps
• Growls/Barks Bites

Why are you in need of rehoming your dog? *

Upload Picture(s) of your dog: *

Click or drag files to this area to upload.

You can upload up to 3 files.

(Upload picture(s) in .jpg, .png or .gif format – files up to 128 MB)

Submit Request