Owner Surrender Form Owner Surrender Form If you are human, leave this field blank. In-Take Questionnaire for Owner Surrenders Please answer these questions honestly. It is very important that we get a TRUE representation of your dog’s disposition and personality, so that he/she may be placed in the best and most appropriate foster home and/or adoptive home. There are NO right or wrong answers. Name * Address * City, State, Zip Code * Cell Phone * Home Phone * Email * Boxer's name * Gender * Male Female Boxer's age * Is the tail natural or docked? * Is your dog spayed or neutered? * Yes No Is your dog on monthly Heartworm prevention? * Yes No Is your dog current with vaccinations? * Yes No Vet name and phone number * I will provide vet records for this dog * Yes No How long have you lived with this dog? * Where did you get this dog? * Is your dog an indoor or outdoor dog? * Any health concerns...special diet, seizures, tumors, etc.? * Is your dog crate trained? * Is your dog housebroken? * Does your dog get along with other dogs? * All Male Female Only smaller dogs No Not sure Does your dog like children? * Yes, all ages Yes but too strong for a toddler No Not sure Does your dog get along with cats? * Are there any behavior issues we should be aware of? If yes, please explain. If no, enter N/A. * Has your dog ever bitten anyone? If yes, please explain. If no, enter N/A * Why are you needing to surrender your boxer? * Specifically, when does your boxer need a new home by? * To the best of my knowledge all the information given on this form is true and correct. * Yes No reCAPTCHA Submit
