Red Dirt Boxer Rescue:  Owner Surrender Form

 Via Email

INSTRUCTIONS:

1.  Highlight the below Owner Surrender Questions. Right Click>Copy.

2. Click to open an email to us. Red Dirt Boxer Rescue

3. Right Click>Paste the questions into the open email.

4. Put your FULL Name and Boxer's Name in the subject line where indicated.

5. Complete Your Answers.   Indicate check box choices by replacing with an X

6. Hit Send.

Owner Surrender Form

Make sure you have exercised all options, health, behaviors, etc. If you would like to discuss this decision with a volunteer please email Surrender@RedDirtBoxerRescue.com or call (580) 656-4726. We may be able to assist you with dealing with the problem at hand as opposed to giving up your Boxer.

If you made the final decision regarding giving up your dog, the following steps apply:

Dogs Name: _________________________                    Age: _____________________________

Date of Birth (if known): _______________________________

Sex: ( ) Male ( ) Female

Color: ( ) Fawn  ( ) Brindle  ( ) White

Owners Name: ________________________________________

Email Address: ________________________________________

Address: _____________________________________________

Home Phone number: ______________________ Cell Phone Number: ______________________

Veterinarian(s) Name, Address, Phone Number: __________________________________________

________________________________________________________________________________

________________________________________________________________________________

I would like to find my Boxer a home by the following date: _______________________________

Reason for Surrender: _____________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Has the dog been: ( ) Spayed  ( ) Neutered  ( ) Not spayed or neutered

Has the dog been bred? ( ) Yes  ( ) No  ( ) Unknown

Has the dog been injured? ( ) Yes  ( ) No

Owner Surrender Form - continued

If yes to the above question, explain: __________________________________________________

________________________________________________________________________________

Does the dog have any known medical conditions (i.e. allergies, seizers, etc.) __________________

________________________________________________________________________________

Is the dog current on vaccinations (shots)? ( )Yes  ( ) No

Where does the boxer live? ( ) Urban ( ) Suburban ( ) Rural ( ) Farm

Does the dog live in? ( ) House  ( ) Condo  ( ) Apartment  ( ) Garage

If the dog is inside, where does it sleep? (please “X” all that apply):

            ( ) Dog Bed  ( ) Owners Bed  ( ) Cellar/Basement  ( ) Crate  ( ) Couch  ( ) Floor

Is the dog aggressive towards people? ( ) Yes  ( ) No

If yes to the above question, please explain: ____________________________________________

________________________________________________________________________________

Has the dog been around the following animals?

            ( ) Large dogs  ( ) Small dogs ( ) Cats  ( ) Birds  ( ) Livestock

Is the dog an only dog or in a multiple dog household? ( ) Only  ( ) Multiple

List the age, sex, type of other dogs/cats in the household:

1.)______________________________________________________________________________

2.)______________________________________________________________________________

3.)______________________________________________________________________________

4.)______________________________________________________________________________

5.)______________________________________________________________________________

Owner Surrender Form – continued

How many hours is the dog used to being left alone during a normal day?

            ( ) Occasional brief periods                   ( ) 6 hours or less

            ( ) 6 – 8 hours                                      ( ) 8 hours or more

Is the dog housebroken? ( ) Yes  ( ) No  ( ) some accidents  ( ) frequent accidents

Is the dog crate trained? ( ) Yes  ( ) No

How do you excersise your dog? (please “X” all that apply)

            ( ) leash walks  ( ) jog with owner  ( ) throw stick  ( ) fenced yard  ( ) dog is couch potato

Please describe the temperament of the dog: ___________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Does the dog enjoy car rides? ( ) Yes  ( ) No

Is the dog hand shy? ( ) Yes  ( ) No

Does the dog spook easily? ( ) Yes  ( ) No

Please select anything that the dog is afraid of: (please “X” all that apply)

            ( ) loud noises ( ) men ( ) veterinarian ( ) vacuum ( ) broom ( ) thunder ( ) cars

            ( ) people in uniform ( ) fireworks ( ) sirens ( ) children

Please select any bad habits or behavioral problems that the dogs has: (please “X” all the apply)

            ( ) chews furniture/clothing ( ) jumps fences ( ) bites ( ) separation anxiety

            ( ) digs holes ( ) barks excessively ( ) counter surfs ( ) overprotective