Shelter Intake Form

    Hello!

    My name is Whitney Fritzinger and I am the Intake Coordinator with Nebraska Border Collie Rescue, Inc. (NBCR) We prioritize Border Collies and Border Collie mixes in and around the state of Nebraska. If you have a Border Collie that you feel would benefit from being brought into NBCR, please fill out the form below.

    Thank you!

    Contact Information
    Name:

    Phone Number:

    Email Address:

    Shelter Name:

    Shelter Address:

    Shelter Phone Number:

    Why have you contacted NBCR for this dog?

    Dog's name:

    Dog's Age:

    Dog's Gender:

    What vaccinations is the dog current on? Please include due dates.
    BordatellaLeptoRabiesParvoDistemper

    Is the dog microchipped?
    YesNo

    What is the name and contact information for your current veterinarian? Please provide or attach veterinary records.

    Is the dog intact or altered (spayed/neutered)?
    IntactSpayedNeutered

    Has the dog had any kind of training?
    Potty TrainedCrate TrainedHousebrokenBasic ObedienceCompetition ObedienceHerding

    Does the dog have experience with sheep or cattle or herding?
    YesNo

    Is the dog house trained? Please describe anything we should know.

    How would you describe the dogs behavior on leash? Do they pull? Do they wear?

    Has the dog been regularly exposed to children? If so, what ages, genders and at what frequency?

    Has the dog been exposed to small animals? Please describe.

    Has the dog been exposed to other dogs?

    How do they interact with dogs of the same size?

    Dogs that are larger?

    Dogs that are Smaller?

    Dogs that are the same gender?

    Dogs that are opposite gender?

    Does the dog display any aggression towards humans?

    Does the dog have a known bite history?

    Does the dog display any aggression towards dogs?

    Does the dog display guarding behavior of resources? (food, toys, etc)

    Does the dog have any medical conditions?

    Has the dog escaped enclosure such as a fenced area like a yard or kennel run? If so, what was the height and make of the fence? (examples: chain link, vinyl privacy, wood privacy, wrought iron, etc.)

    Where does the dog spend the majority of their time; indoors or outdoors?

    When indoors, where does the dog spend their time when they are unsupervised?

    When indoors, where do the dog spend their time when they are supervised?

    When outdoors, where does the dog spend their time when they are unsupervised?

    When outdoors, where does the dog spend their time when they are supervised?

    Please attach any relevant medical records or pictures.