Owner Surrender Form Owner Surrender Form 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. Please place a N/A in the box if the question does not pertain to you. Name * Address * City, State, Zip Code * Cell Phone * Other Phone * Email * Boxer's name * Gender * MaleFemale Boxer's age * Boxer's date of birth if known * Is the tail natural or docked? * Is your dog spayed or neutered? * YesNo 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. from the dog without any problems?) * No, he/she does not resource guardYes, he/she resource guards If you answered yes to above question please explain in detail the behavior your dog exhibits * 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? * Is there any additional information about your dog that you would like to add so that he/she is placed in the most appropriate home? * Please check the items that will be accomanying your dog to his/her foster/new home. * Collar Leash Harness Food Crate Necessary Medications Heartworm Preventative Blanket Favorite Toys A donation to Boxer Friends, Inc. is suggested however it is not required. The amount of my donation to Boxer Friends, Inc. is ______________. I understand that this donation will be used to bring my dog up to date on vaccinations (as required by law in Broward County). My donation can also be used to pay for spay/neuter of my dog (if applicable) so that he/she may be adopted. * $25. $50. $100. Other 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. * YesNo CAPTCHA Submit
