First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County*

Email*

Home Phone

Cell Phone*

Alt Email

Please state your name. *

What is your complete physical address including City, State, and Zip Code?*

What is your home phone number, and/or cell phone number where you can be reached during the day?*

What is the email address we can contact you at? *

Please provide the name, address, and telephone number of the breeder or persons from whom you received the dog?*

What is the name of your Boxer?*

What is the age or date of birth of your Boxer?*

How long have you owned the boxer you are surrendering?*

What is the reason you are having to surrender your boxer?*

What is the Name, address, phone number, fax number for the vet who last cared for your Boxer?*

Please fully describe your dogs personality, such as friendly, protective, shy, noisy, quiet, active, playful, nervous, smart, affectionate, obedient, and calm) Please be as detailed as possible.*

Is your dog microchipped? If so, please list the brand and microchip number.*

What are the last dates of the following vaccinations? Please make sure to send all vet records with your Boxer. Rabies DHLPP Bordetella Lyme Any others?*

What was the date of the last heartworm test for your Boxer? Was it negative or positive?*

Is your Boxer currently on heartworm preventive? If so, when was it last given and which brand?*

Do you give your boxer flea and tick preventive*

What brand of flea and tick preventive do you use?*

What is the date your Boxer last received flea and tick preventive?*

Does your Boxer suffer from any allergies? If so, please tell us what allergies.*

Has your Boxer been spayed or neutered? If not, what were the reasons you did not spay or neuter?*

Are there any medical issues that your Boxer has either had in the past, or currently has?*

If yes, what were those issues, and were those issues treated, or are they currently being treated?*

Is your Boxer currently on any medication? If yes, what are the names and dosages of the medications, and how frequently does your Boxer take these medications?*

Is your Boxer housebroken*

If your Boxer is partially housebroken, please describe in detail when accidents occur? *

Does your Boxer have any behavior issues? If yes, please describe in detail.*

Does your Boxer get along with other dogs?*

If yes, does your Boxer get along with both male and female dogs? *

Please describe in detail how your Boxer reacts when meeting new dogs.*

Does your Boxer like cats?*

Please describe in detail how your Boxer reacts to cats? (does your Boxer want to eat the cat, play with the cat, ignore the cat, stare down the cat, chase the cat)*

Please describe in detail any exposure to other animals, such as horses, pigs, birds, rabbits?*

Does your Boxer have a high prey drive?*

Has your Boxer ever been around children?*

If yes, what ages of children has your Boxer been around?*

How does your Boxer behave around children? (playful, gentle, rough etc.)*

Does your Boxer like both men and women?*

Please describe in detail how your Boxer interacts with men and/or women?*

What brand of dog food do you feed your Boxer?*

How much food do you feed your Boxer on a daily basis?*

How many times a day is your Boxer fed?*

Where does your Boxer sleep at night?*

Do you allow your Boxer(s) to lay on the furniture?*

Do you work? If so, where does your Boxer stay while you are at work?*

Is your Boxer crate trained?*

Describe what your crate is like (wire, Vari Kennel, etc.) Please include size/dimensions of crate.*

Please describe in detail how your Boxer reacts when crated?*

Describe in detail how your Boxer reacts when he/she is left alone?*

Is your Boxer afraid of anything? If yes, please list what fears your Boxer has. Please be very specific.*

Has your Boxer been to any type of obedience training classes?*

Does your Boxer know any tricks? If yes, please describe.*

Please describe in detail how your Boxer reacts when riding in the car?( do they get sick, anxious, fearful, calm, etc.)*

What are your Boxers favorite toys?*

What things does your Boxer most like to do?*

Is there anything your Boxer dislikes? Please be as detailed as possible.*

Is your Boxer on any exercise routine? (jogging, walking, etc.) Please describe in detail*

Does your Boxer like to dig?*

Please describe your yard in detail? (fencing, acreage, etc.)*

Can your Boxer jump fences or baby gates? If so, please describe height/type fence your Boxer can jump.*

Does your Boxer have any aggressive behaviors? (fence, food, people, dogs, etc.) Please describe in detail. *

Is there any other information you can provide to help us make your Boxer's adjustment easier on him/her? *

By signing below you certify that the above information is correct. You also acknowledge that IF you are approved to surrender, Minnesota Boxer Rescue becomes the lawful owner of the Boxer, and you relinquish all lawful rights to your Boxer.*