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 old was the dog when you acquired him/her? * How long have you lived with this dog? * Where did you get this dog? (shelter, breeder, pet store, etc.) * Is your dog an indoor or outdoor dog? * Where does the dog sleep at night? * Where is the dog kept when no one is home? * On average, how many hours is the dog alone (without humans) each day? * Any health concerns...special diet, seizures, tumors, etc.? * Has your dog been through basic obedience? If so, where and when. * Is your dog crate trained? Does he enjoy his crate? Is he afraid of the crate? * Is your dog potty trained? How are potty accidents handled in your home? * Does your dog know how to potty on command? If so, what is the command? * 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? * What does your dog not like? * What food does your dog eat? How much? How many times a day and what time(s)? * How well does your dog walk on a leash? * Walks well Needs some training Pulls excessively 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 * Does your dog resource guard? Can you take away a bone, toy, etc. without any problems? * List some of your dogs favorite things * Is your dog allowed on the furniture? * Does your dog dig in the yard? * Has your dog ever bolted out of the front door when it's opened?? If so, will he come back if called? * Does your dog chew on inappropriate items? Furniture, children's toys etc.? * How is behavior modification handled in your home (how do you handle punishing your dog)? * What commands if any does your dog know? * 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 I have given true statements about my dog’s disposition and personality. I freely sign custody of my dog over to Boxer Friends, Inc. so that THEY may place my dog in a home that best fits what I have described above. I relinquish all claim to the above dog. * Yes No reCAPTCHA Submit
