First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Cell Phone*
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 the veterinarian who last treated and vaccinated this dog:*
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.*
Date of most recent Lymes 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.*
Provide the date of the last heartworm test. Enter N/A if no test performed.*
What were the results of the heartworm test?* Choose one: Negative Positive no test given
What brand of Heartworm Preventative does the dog take? Enter N/A if not taking preventatives.*
When was the last preventative given? Enter N/A if not taking preventatives.*
Is the dog spayed or neutered?* Choose one: Yes No
Has the dog ever been bred?* Choose one: Yes No Unknown
When was the dog last tested for parasites? Enter N/A if never tested*
If the dog was tested for parasites, what were the results?
If the dog has had parasites, was it treated? 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?
What brand of dog food is the dog fed? *
Is the food:* Choose one: canned dry Semi-moist combination
How much does the dog eat (per meal)?*
How often is the dog fed?*
Are there any special feeding instructions you want to share?
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
Has an Animal Control Officer or Police Officer ever been called to address an issue caused by this animal?* Choose one: Yes No
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.
Once your application has been submitted, send pictures to intake@boxerluv.org from the email address provided in the application Choose one: Agree