First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County

Email*

Home Phone

Work Phone
x

Cell Phone*

Alt Email

If you are returning an dog you adopted from Houston Boxer Rescue(HBR), please stop filling out this form and go to the Houston Boxer Rescue(HBR) Dog Return form.*

Can you foster the dog until it is adopted?*

Is your dog leash trained?

Is your dog a mix breed dog?*

If your dog is a mixed breed, are you willing to financial support this dog until a forever home is found? This means, paying the vet bill, medications, food, etc.*

If you are unwilling to financially support this dog and or foster it until we can find a forever home, HBR cannot assume this responsibility. We are a purebred Boxer Rescue. We have to turn away purebreds on a daily basis. If you are unwilling to foster and financially support the mixed breed dog, please do not complete this application. Look for a mixed breed rescue group.*

What is the name of the dog?*

What color(s) is the dog?*

What is the estimated age of the dog?*

Are the ears natural/floppy or cropped/pointed? *

Is the tail docked(short, cut)?*

What is the sex of the dog?*

Is there any chance this dog is pregnant?

Does this dog have puppies?

Is the dog microchipped?*

If the dog is microchipped, please provide the details:

What is the name and phone number of the vet who has seen this dog?*

Does your dog have a medical condition? Example: Allergies, heart murmur, chronic ear infections, etc. If the answer is yes, please tell us all about the condition.*

What brand dog food are you feeding this dog? example: Purina Pro chicken, Blue Buffalo Lamb and rice.*

Is the dog current on heartworm prevention?*

What type of Heartworm Prevention has been given to the dog?

When was the last time this dog was given heartworm or flea and tick prevention?

Is the dog current on vaccines?*

Is the dog spayed or neutered*

Is the dog friendly with other dogs?*

If the dog is or is not dog friendly, how do you know?*

Is the dog cat friendly?*

Is the dog good with children?*

Is the dog crate trained?*

Is the dog house trained/potty trained?*

Where do you keep the dog?*

Can the dog jump a 6 ft. fence?*

Has the dog shown any behavior problems? food aggression, fear biter, etc. Please describe:*

How does the dog behave when it is left alone?*

Is this dog your personal dog?*

Why are you surrendering this dog?*

If the dog is a stray, where was it found? Be as specific as possible.

How long have you had possession of the dog?

Please tell us about this dog; likes, dislikes, example: loves riding in car, hates fireworks?

I hereby forever relinquish all claims to and ownership of said dog to the organization known as “Houston Boxer Rescue” hereinafter referred to as “HBR”.*

It is my intent to surrender to HBR all of my ownership rights and all other interests of any kind pertaining to the dog. *

I understand that I cannot reclaim this dog once the dog is in the possession of HBR.*

I agree to give HBR the dog’s AKC registration papers, if any, and all medical records available.*

I understand that the final decision as to any adoption belongs to HBR. *

I understand that completing the Owner/Stray Surrender Form is NOT a guarantee HBR will accept this dog into their program.*

I certify the information entered on this document is correct and by typing my signature I hereby complete the release of the above dog to HBR.*

Date:*

Thank you for completing this form.

Please email pictures and vet records to surrender@HoustonBoxerRescue.org

Please include the dog's name in the Subject Line with Owner/Stray Surrender.