First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Home Phone

Work Phone
x

Cell Phone

Alt Email

Was your dog originally adopted from Houston Boxer Rescue?*

What is the name of the dog now?*

What was the name of the dog when it was with Houston Boxer Rescue before you adopted it?*

What year did you adopt your Houston Boxer Rescue dog?*

How Old is the Dog?*

We require pictures and video's of the dog prior to accepting the dog back into our program. If we do not receive these items, we will close your application after 72 hours. Pictures should include: full body of dog, teeth and head. Video should include dog with humans and other dogs.

I agree to give HBR all medical records for 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.*

Is the dog current on vaccines?*

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

Can you foster the dog until it is adopted?*

Is your dog leash trained?

Is the dog cat friendly?*

Is the dog good with children?*

Is the dog friendly with other dogs?*

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

Can the dog jump a 6 ft. fence?*

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

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

Is the dog current on heartworm prevention?*

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

Why are you surrendering this dog?*

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”.*

As per your contract with HBR, “If for any reason Adopter is unable to keep said dog it is to be returned to HBR with a minimum of (21) days notice. Transportation back to HBR is the sole responsibility of the Adopter. If the dog must come into rescue sooner and a foster home cannot be found, the Adopter is responsible for all boarding and veterinary fees incurred. Under NO circumstances shall the Adopter place said dog with any person, rescue group, foster home, agency, or Humane Society. If after the (21) days HBR is unable to take back the dog for whatever reason, the Adopter may place the dog after giving HBR an additional (7) days notice of intent to do so. Further, Adopter must provide HBR with information on potential placement and potential placement must go through the HBR screening process. If no notification is given to HBR and it is found out that the dog changed ownership under the condition of this contract the Adopter must pay HBR $500.00. PLEASE INITIAL*

I agree that typing my name is the same as signing my name to this document. I agree this to be a legal signature on this document. INITIAL*

Sign your name by typing it.*

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 HBR Dog Return.