First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Work Phone
x

Cell Phone*

Alt Email

Dog's Information

What is the dog's name*

How old is the dog?*

Is the dog male or female?*
Choose one: Female Male

How much does the dog weigh?*

What is the dog's color (fawn, brindle, etc.)*

Where did you get the dog? Provide name, address, phone number of breeder, shelter or individual.*

How long have you owned the dog?*

Why are you giving the dog up?*

The following questions will be of help to the person who will adopt your dog. If there is anything you would like to add that may make your pet's adjustment to a new home easier, please feel free to share that information. We want to make the adoption a success and will work hard to have happy owners and happy dogs. Select the words that describe your dog. To select multiple options, hold down Ctrl and select each word that applies

Provide the name, address, and phone number of your Boxers Veterinarian. Reply NA if your Boxer doesn't have a veterinarian*

When was the last time your Boxer was seen by a veterinarian? Reply NA if not known*

Is the dog current on vaccinations?*
Choose one: Yes No

Date of most recent Rabies vaccination. Enter N/A if no vaccination given.*

Date of most recent Distemper, Hepatitis, Leptospirosis, Parainfluenza, Parvovirus (DHLPP) vaccination. Enter N/A if no vaccination given. *

Date of most recent Bordatella vaccination. Enter N/A if no vaccination given.*

List any other vaccinations and their dates. Enter N/A if no other vaccines have been given.*

Is the dog spayed or neutered?*
Choose one: Yes No

List any medications and dosage the dog is currently taking. Enter N/A if no medications.*

Is the dog housebroken?*
Choose one: Yes No Partly

If partly, describe when accidents occur:

Does the dog have behavior problems?*
Choose one: Yes No

If yes, describe.

Does the dog get along with other dogs?*
Choose one: Yes No Unknown

Does the dog get along with cats*
Choose one: Yes No Unknown

Does the dog get along with other animals? (small pets, livestock, etc.)*
Choose one: Yes No Unknown

Does the dog like children?*
Choose one: Yes No Unknown

Are there children in the home?*
Choose one: Yes No Currently have no pets

If yes, what are their ages?

Where does the dog sleep?*

Is the dog allowed on the furniture?*
Choose one: Yes No Currently have no pets

Is the dog crate trained?*
Choose one: Yes No Unknown

Where is the dog kept during the day?*

Where is the dog kept at night?*

How does the dog act when left alone?*

Is the dog afraid of anything in particular? (Thunder, men, hats, brooms, uniforms, etc.)*

Describe any training the dog has had, or tricks it has learned.*

Describe any health problem the dog has.*

Does the dog like riding in the car?*
Choose one: Yes No Unknown

What is the dog's favorite toy or plaything?*

What does the dog like?*

What does the dog dislike?*

Does the dog jump over fences or kiddie gates? *
Choose one: Yes No Unknown

If the dog jumps over gates/fences, how high does it jump?

Does the dog dig?
Choose one: Yes No Unknown

Describe any special, unusual, or endearing traits the dog has.

Is there anything else you think a new owner should know?

Has this animal caused injury with a bite to a human or other animal?*
Choose one: Yes No

If you answered yes to the above question, please explain:

Has this animal bitten any human but not caused injury? *
Choose one: Yes No

If you answered yes to the above question, please explain:

Has an Animal Control Officer or Police Officer ever been called to address an issue caused by this animal?*
Choose one: Yes No

If you answered yes to the above question, please explain:

By submitting this form, you are relinquishing all claims and ownership of said dog to the organization known as Boxer Luv Rescue ("Rescue") and members thereof. You acknowledge you cannot reclaim this dog once the dog is in the possession of Rescue and understand this animal will be spayed or neutered, if needed. You agree to give up the dog's American Kennel Club registration papers and all medical records available. Neither Rescue nor members thereof shall be responsible for actions of the adoptive or foster family and/or dog. The dog may be euthanized for extreme aggression or illness if Rescue deems it necessary but this is always the last resort after all other measures have been exhausted. You certify this dog is not vicious and has never shown signs of aggression towards human beings.

Signature acknowledgement (type your name)*

Once your application has been submitted, send pictures to intake@boxerluv.org from the email address provided in the application
Choose one: Agree