MustLuvBoxers Rescue Owner Surrender Form

Owner Surrender Form Requirments

If you are needing to surrender your Boxer to MustLuvBoxers Rescue please complete the following:
- The below questionnaire form with as much information as possible
- Upload a minimum of two photos of the dog
- Upload all past medical records such (vaccinations, spay/neuter, medical care, etc.)
Upon completition of the above items a representative of MLBR will be in touch with you within 48 hours. If this is an emergency please call us directly at (206) 778-9457.
Owner Information
Primary Owner Name*

First NameLast Name
Secondary Owner Name (if applicable)

First NameLast Name
Primary Phone Number*

Area CodePhone Number
Secondary Phone Number (if applicable)

Area CodePhone Number
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Primary Owner's Employer
Primary Owner's Occupation
Are you the sole owner of the dog?*

YesNo
Dog Information
Dog Name*
Dog Sex*

MaleFemale
Dogs age and/or birthdate *
Dog color *
Breed of dog*

Purebred BoxerOther
Is the dog spayed/neutered?*

YesNo
Is the dog microchipped?*

YesNo
Microchip number
Dog Medical History
Are vaccinations up to date?*

YesNoUnknown
Is the dog current on Distemper/Parvo Shot?*

YesNoUnknown
Has your dog been heart worm tested in last year?*

YesNoUnknown
Has your dog received heartworm preventative this year?*

YesNoUnknown
Has your dog received flea tick/prevention in the last year?*

YesNoUnknown
What type and when was the flea/tick prevention last given?
Has your dog ever been bred?*

YesNoUnknown
Has dog ever had puppies?*

YesNoUnknown
What is the current brand of dog food your feeding?*
How many times a day do you feed your dog? *
How many cups do you feed at each meal? *
How long have you owned this dog?*
How many owners has this dog had? *

Does the dog have any of the following health issues?*

	Yes	No	Unknown
Seizures
Ear problems/recurring infections
Hip dysplasia
Arthritis
Other orthopedic problems
Allergies
Other medical conditions

Please explain any "yes" answers provided above
Veterinarian Information*
Veterinarian Name, Location, and Phone Number
I authorize the clinic/doctor referenced above to release ALL records pertaining to the dog indicated above.*

Agree
Dog Behavior & Environment
Is your dog house broken?*

YesNoUnknown
Is your dog crate trained?*

YesNoUnknown
Is your dog a digger?*

YesNoUnknown
Has your dog ever jumped a fence or attempted to jump a fence?*

YesNoUnknown
Is your dog leash trained?*

YesNoUnknown
Does your dog frequently bark?*

YesNoUnknown
Has your dog been through obedience training?*

YesNoUnknown
Is your dog aggressive towards other dogs?*

YesNoUnknown
Explain in detail why you are surrendering your dog. *
Please be as detailed as possible
What are the dog's bad points (i.e. behavior issues, aggression, counter surfing, digging, etc.)?*
Please be as detailed as possible
What are the dog's good points?*
Please be as detailed as possible
Please describe how your dog interacts with other dogs. *
Please be as detailed as possible
Where is the dog kept?*

InsideOutsideKennelOther
Has the dog lived with children?*

YesNoUnknown
What are the ages of the children?
Has the dog lived with dogs or cats?*

Dog(s)Cat(s)Both dog(s) and cat(s)None of the aboveOther
Does the dog know any commands (sit, stay, go to bed, etc.)?*
Is the dog home alone during the day?*

YesNoUnknown
How many hours per day is the dog alone?*
Any other comments/information:
Please upload at least two photos:

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Please upload any vet records you have:

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INITIAL: I understand that MustLuvBoxers Rescue does not buy nor pay for dogs. This is a service to help place boxers in new homes when their present owners can no longer keep them. This service is free, however a donation to help pay for expenses is appreciated. Most of the dogs we handle are from animal shelters and require considerable expenses prior to adoption. Everyone associated with MustLuvBoxers Rescue are volunteers.*
INITIAL: The information that I have provided regarding the previously mentioned dog is true and complete. I hereby forever release, discharge and agree to hold harmless and indemnify toMustLuvBoxers Rescue, its board of directors, its members, officers, and agents, past, resent, and future from all claims, demands, actions, causes of action, and/or liability of any kind whatsoever arising as a result of/or in connection with the adoption/or other disposition of the above named dog.*
INITIAL: I hereby relinquish all rights of the above named dog, to MustLuvBoxers Rescue. I hereby certify that I am the owner of this dog, free and clear of all other interests. I hereby certify that this dog is not possessed of any dangerous and/or vicious propensities, and that I have not willfully concealed any information about the dog that might indicate such propensities. I further understand and agree that I received no money or other compensation as a result of this surrender.*
Date

MonthDayYear
Date
Signature

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Thank you for taking time to fill out an owner surrended form and for trusting us with your canine family member.

A MustLuvBoxers Rescue representative will be in contact with your regarding your surrender as soon as possible.

If you have any questions or concerns about the form please feel free to call or email us.

Phone: (206) 778-9457

email: mustluvboxersrescue@comcast.net
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Should be Empty:

Owner Information

Dog Information

Dog Medical History

Dog Behavior & Environment