First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone*

Work Phone*
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Cell Phone*

Alt Email*

Please provide the name, address, and telephone number of the breeder or persons from whom you received your Boxer. *

What is the name and age of the Boxer you are surrendering?*

How long has your Boxer lived with your and your family?*

Please provide a detailed reason as to why you need to surrender your Boxer?*

Please provide the name, address, phone number of the vet who provided medical care for your Boxer. *

Is your Boxer male or female? Is your Boxer spayed/neutered?*

Is your Boxer current on all vetting? Including vaccinations, spay/neuter, heartworm test, heartworm medication, fecal test. Please provide dates of current vetting.*

Are there any health issues we need to be aware of? If yes, please describe in detail.*

Is your Boxer fully housebroken? If only partially, please describe in detail when accidents occur. *

Please fully describe your Boxer's personality, such as friendly, protective, shy, noisy, active, playful, nervous, etc. Please be as detailed as possible. *

Does your Boxer get along with other 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? *

Has your Boxer been exposed to any other type of animals, such as livestock? Please describe in detail.*

Has your Boxer been around children? What ages? How does your Boxer react when around children?*

Does your Boxer like both men and women? Please describe in detail how your boxer interacts with both men and women.*

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

Where does your Boxer sleep at night? *

Do you allow your Boxer's on the furniture? *

What are your Boxer's favorite toys? *

Is your Boxer afraid of anything? If so, please describe in detail.*

How many hours a day is your Boxer left alone? Describe in detail how your Boxer reacts to being left alone.*

Is there anything your Boxer dislikes? Please describe in detail. *

Please describe your Boxer's exercise routine. *

Please describe your yard in detail, including any type of fencing.*

Can you Boxer jump fences or baby gates?

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 Across America Boxer Rescue becomes the lawful owner of the Boxer, and you relinquish all lawful rights to your Boxer.*