Great Lakes Boxer Rescue Owner Surrender

Name of dog:

Age of dog:

Sex:

Please provide Vet's information: Name, address, phone

What kind of food do you feed your dog?

How long have you had this dog?

Why do you want to surrender your dog?

Is the dog spayed or neutered?

Is the dog microchipped?

Has the dog been tested for heartworms?

Is the dog on HW preventative?

Has the dog been bred?

Is the dog good with children?

Is the dog good with other dogs?

Is the dog good with cats?

Has the dog ever bitten a person or other animal? Provide details.

Is the dog crate trained?

Is the dog potty trained/house broken?

Please list date of last vaccines. Please list each vaccine and date administered.

Is the dog on any medications? If so, please list.

Does the dog have any know fears? If so, please explain.

How is your dog riding in a car? Please describe in detail if he/she needs a crate, gets car sickness, etc?

Please list any health issues your dog has. Be specific.

Tell us anything else about your dog. Any traits, any other information we should know.

Please sign and date here that you are willingly surrendering your dog to Great Lakes Boxer Rescue. Upon a volunteer confirming your surrender, the dog will be in the care going forward of Great Lakes Boxer Rescue.