Animal Surrender Form
Name
*
First Name
Last Name
Phone
*
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
DOG & HOUSEHOLD INFORMATION
When do you need to surrender the boxer?
*
Dogs Name
*
Sex
*
Male
Female
Age
*
Is the boxer
*
Purebreed
Mix
Tail
*
Docked
Natural
How long have you had the boxer?
*
Where did you get the boxer?
*
Why are you surrendering the boxer?
Including yourself, how many people of the following ages live in your home?
*
Rows
FEMALE
MALE
00 - 03
04 - 09
10 - 17
18 - 29
30 - 59
60 +
1
What other animals did the boxer live with?
*
no other animals
dogs
cats
Other
BEHAVIOR
Your dogs usual behavior
How does the boxer usually behave towards people they know?
*
Rows
never encounter
friendly
afraid
show teeth/growl
snaps
bites
other
men
2
3
4
5
6
7
8
women
9
10
11
12
13
14
15
children
16
17
18
19
20
21
22
How does the boxer usually behave towards people they DO NOT know?
*
Rows
never encounter
friendly
afraid
show teeth/growl
snaps
bites
other
men
23
24
25
26
27
28
29
women
30
31
32
33
34
35
36
children
37
38
39
40
41
42
43
How does the boxer usually behave towards animals they know?
*
Rows
never encounter
friendly
afraid
show teeth/growl
snaps
bites
other
dogs
44
45
46
47
48
49
50
cats
51
52
53
54
55
56
57
How does the boxer usually behave towards animals they DO NOT know?
*
Rows
never encounter
friendly
afraid
show teeth/growl
snaps
bites
other
dogs
58
59
60
61
62
63
64
cats
65
66
67
68
69
70
71
Comments on answers above
How does the boxer usually react when an unfamiliar person approaches or enters the yard or house?
*
friendly
afraid
barks
shows teeth/growls
will bite
Is the boxer housetrained?
*
yes
no
partially
How does the boxer let you know they need to go out?
*
Where does the boxer spend the majority of their time?
*
inside the house, runs free
inside the house, crated
outside the house, runs free in yard
outside the house, kennel
outside the house, tied up
Other
How many hours a day is the boxer left alone without a human?
*
never
1-3 hours
4-8 hours
9-12 hours
over 12 hours
When left alone, is he/she...
*
outdoors
free roam in home
confined to a room
crated
Other
When left alone, does boxer usually show any of the following behaviors?
*
destroy household items
urinate/defecate
bark
cry
none of these
Other
When the boxer plays, do they typically...
*
jumps
growls
barks
bites lightly
bites hard
none of these
Other
What toys does the boxer like?
*
balls
frisbee
plush
squeaky
tug toy
none
Other
What games does the boxer like?
*
fetch
tug
chase
wrestling
none
Other
Is the boxer scared of anything
*
yes
no
If yes, please explain
Please tell us the boxers bad habits
*
Is the boxer allowed on furniture?
*
yes
no
Where does the boxer usually sleep at overnight?
*
crate
floor
your bed
couch
kids bed
dog bed
outside
Other
What commands does the boxer know?
*
no commands known
sit
down
stay
come
leave it
place
heel
Other
Describe the boxers leash skills
*
Describe the boxers reaction if a person or other dog gets near or attempts to take food he is eating.
*
Describe the boxers reaction if a person or other dog attempts to take a toy they are playing with.
*
Describe the boxers reaction if a person or other dog attempts to take a bone or other treat they have
*
Describe the boxers reaction if touched when sleeping.
*
Does the boxer have problems riding in car?
*
yes
no
don't know
If yes, please explain
Has the boxer escaped your property 2 or more times in the last 6 months?
yes
no
If yes, please explain
AGGRESSIVE BEHAVIOR
(behavior that has ever happened)
Has the boxer ever attacked or bit a person?
*
yes
no
If yes, please explain
Has the boxer ever attacked or bit another dog?
*
yes
no
If yes, please explain
Has the boxer ever attacked or bit a cat?
*
yes
no
If yes, please explain
Has the boxer ever attacked or bit farm animals? (chickens, horses, cows, goat, pig, sheep, etc...)
*
yes
no
If yes, please explain
MEDICAL
Please list all veterinarians that have seen the boxer, including address and number.
*
Does the boxer see a veterinarian at least once a year?
*
yes
no
Is the boxer spayed/neutered?
*
yes
no
What vaccinations has the boxer recieved?
*
rabies
dhhp
bordatella
none
Are vaccinations current?
*
yes
no
Has the boxer been tested for heartworm?
*
yes
no
If yes, what were test results
Is the boxer taking heartworm preventative?
*
yes
no
If yes, when is the next dosage due?
Is the boxer microchipped?
*
yes
no
Check if the boxer has ever shown any of the following behaviors when handled by a vet or groomer.
*
Rows
never done
shows teeth/growls
snap
bite
none of these
examine
72
73
74
75
76
restrain
77
78
79
80
81
administer shots
82
83
84
85
86
bathe
87
88
89
90
91
clean ears
92
93
94
95
96
trim nails
97
98
99
100
101
take blood
102
103
104
105
106
Does the boxer have to be muzzled at the veterinarians?
*
yes
no
Does the boxer have any past or present health problems?
*
yes
no
If yes, please describe
Is the boxer currently taking any medication?
*
yes
no
If yes, please list medications
FEEDING
What type of food does the boxer eat?
*
canned
dry
soft
table scraps
raw
home cooked
How many times a day is boxer fed?
*
1 time
2 times
3 times
free feeds
How much is fed per feeding?
*
1 cup
1 1/2 cup
2 cups
2 1/2 cups
not sure, just fill the bowl up
Other
Does the boxer get treats?
*
yes
no
If yes, what treats does boxer like?
OTHER
Please feel free to tell us any other information about the boxer you feel is important.
Please upload a full body picture of the boxer
*
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Please upload a up close head shot of the boxer
*
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Please upload any records you have for the boxer
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