First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County

Email*

Home Phone

Work Phone
x

Cell Phone*

Alt Email

Can you foster the dog until it is adopted?*

Is your dog a mix breed dog?*

If your dog is a mixed breed, are you willing to financial support this dog until a forever home is found? This means, paying the vet bill, medications, food, etc.*

If you are unwilling to financially support this dog and or foster it until we can find a forever home, HBR cannot assume this responsibility. We are a purebred Boxer Rescue. We have to turn away purebreds on a daily basis. If you are unwilling to foster and financially support the mixed breed dog, please do not complete this application. Look for a mixed breed rescue group.*

What is the name of the dog?*

What color(s) is the dog?*

What is the estimated age of the dog?*

Are the ears natural/floppy or cropped/pointed? *

Is the tail docked(short, cut)?*

What is the sex of the dog?*

Is there any chance this dog is pregnant?

Does this dog have puppies?

Is the dog microchipped?*

If the dog is microchipped, please provide the details:

What is the name and phone number of the vet who has seen this dog?

Is the dog current on heartworm prevention?*

What type of Heartworm Prevention has been given to the dog?

Is the dog current on vaccines?*

Is the dog spayed or neutered*

We require pictures and video's of the dog prior to review. If we do not receive these items, we will close your application after 72 hours. Pictures should include: full body of dog, teeth and head. Video should include dog with humans and other dogs.*

If the dog is or is not dog friendly, how do you know?

Is the dog cat friendly?*

Is the dog good with children?*

Is the dog crate trained?*

Is the dog house trained/potty trained?*

Where do you keep the dog?*

Can the dog jump a 6 ft. fence?*

Has the dog shown any behavior problems? food aggression, fear biter, etc. Please describe:

How does the dog behave when it is left alone?*

Is this dog your personal dog?*

Why are you surrendering this dog?*

If the dog is a stray, where was it found? Be as specific as possible.

How long have you had possession of the dog?

Please tell us about this dog; likes, dislikes, example: loves riding in car, hates fireworks?

I hereby forever relinquish all claims to and ownership of said dog to the organization known as “Houston Boxer Rescue” hereinafter referred to as “HBR”.*

It is my intent to surrender to HBR all of my ownership rights and all other interests of any kind pertaining to the dog. *

I understand that I cannot reclaim this dog once the dog is in the possession of HBR.*

I agree to give HBR the dog’s AKC registration papers, if any, and all medical records available.*

I understand that the final decision as to any adoption belongs to HBR. *

I understand that completing the Owner/Stray Surrender Form is NOT a guarantee HBR will accept this dog into their program.

I certify the information entered on this document is correct and by typing my signature I hereby complete the release of the above dog to HBR.*

Date:*

Thank you for completing this form.

Please email pictures and vet records to surrender@HoustonBoxerRescue.org

Please include the dog's name in the Subject Line with Owner/Stray Surrender.