Owner Surrender Form

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Personal Information

* First name

* Last name

* Email

* Email confirmation

Home phone

Cell number

* Current Address

Current Address 2

* Zip

* City

* GenderMaleFemale

Country

*State/Province

Date of Birth

* Month

* Day

* Year

Information About Your Dog

Dog's Name

Male or Female

MaleFemale

Age

Color

BrindleFawnReverse BrindleWhiteOther

Ears (Cropped or Natural)

CroppedFloppy

Tail

DockedNatural

We are nearing capacity. Will you agree to hold your dog until other arrangements are made?

YesNoTemporarily

Background/History

Where did you get your dog?

How long have you had your dog?

Why are you rehoming your dog?

Medical Information

It is extremely important that we have your Vet information and your approval to verify. We may contact them for more information before approving your application.

Does your dog have a microchip? If yes, provide the chip information below.

Is your dog up to date on vaccinations?

YesNo

What vaccinations has your dog had?

RabiesDHLPPBordatellaOther

Is your dog on heartworm prevention?

YesNo

Has your dog had a heartworm test? If yes, was it positive or negative?

Has your dog had a fecal exam for parasites?

YesNo

Does your dog have any medical issues? If yes, give a short description.

YesNo

List any medications your dog is taking.

List the Vet's name, address and phone number.

Is your dog spayed or neutered?

YesNo

Does your dog have any disabilities [deafness, blindness, arthritis etc]? If yes, please explain below.

Personality Traits

Which of the following best describes your dog? (Check all that apply)

FriendlyShyActiveSmartCalmProtectiveNoisyPlayfulAffectionateQuietNervousObedient

Are there any behavioral problems? If yes, please describe below.

Does your dog get along with other dogs? If no, explain below.

Does your dog get along with children? If no, explain below.

Are there children in your home? If yes, please list the ages below.

Has your dog ever lived with a cat? If yes, how did they get along? Explain below.

Has your dog ever shown signs of aggression toward people? If yes, describe in detail below.

Care and Training

Is your dog house trained?

YesNo

Is your dog crate trained?

YesNo

Describe any special training your dog has had.

What type of food does your dog eat? Are there any specific feeding instructions you wish to share with the new owner?

Where does your dog sleep at night?

Where does your dog stay during the day?

InsideOutsideBoth

How does your dog react to being left alone?

Is your dog allowed on the furniture?

YesNo

Is your dog afraid of anything in particular? Please be as detailed as possible.

Does your dog like riding in the car?

YesNo

Does your dog jump kiddie gates or backyard fences? If yes, describe below.

Is your dog a digger?

YesNo

What is your dogs favorite toy, play thing or favorite pastime?

What does your dog like?

What does your dog dislike?

Is there any additional information we can share with the new owner? Please list anything special, unusual, unique or endearing about your dog.

Ownership Surrender Release Contract

Being the sole owner of the dog described above I hereby forever relinquish all claims to and ownership of said animal to the organization known as “Austin Boxer Rescue” hereinafter referred to as “ABR”. I understand that I cannot reclaim this dog once the dog is in the possession of ABR. It is my intent to surrender to ABR all of my ownership rights and all other interests of any kind pertaining to the dog. I understand that the final decision as to any adoption belongs to ABR. I agree to give ABR the dog’s AKC registration papers, if any, and all medical records available. ABR shall attempt to find the dog a suitable home, but the organization shall not be held responsible for the actions of the adoptive or foster family.

Agreement
When surrendering the dog please bring the following items if you have them:
Toys, bowls, crate, blankets, beds, food and any other items you may have so it will make it easier for the dog to adjust to his/her new home. In addition, we request a MONETARY donation of $50 to 100 to go toward the food and veterinary care for your dog.

Owner Signature waiver: I agree that by typing my name below, that I have read and understood the conditions of the Ownership Surrender Release Contract. Furthermore I agree to abide by the terms of the Ownership Surrender Release Contract.

Enter First and Last Name

Date

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