Please email the completed application to boxeranglesdirectors@yahoo.com or mail or Fax to:
Name:________________________________
Address:__________________________________________________ State ____________ Zip Code: ________________
Phone Number:_________________________ Best time to call:___________________________
Email Address:__________________________
Dogs Name:____________________________ Age/DOB:__________ Color:_______________ Gender:______________
Ears: _____Cropped ______Natural Tail: ____Docked ______Natural Approximate weight: ____________
Please answer the following:
1. Owner Surrender Fee suggested $100.00 _____________________________________________
2. Name, address and telephone number of the Pet Shop, breeder or person you got the dog from:
_______________________________________________________________________________
3. How long have you owned this dog?
_______________________________________________________________________________
4. Why is the dog being given up?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
5. What is the name and address of the veterinarian who last treated and vaccinated this dog?
_________________________________________________________________________________________________
6. Has this dog ever been aggressive or vicious with human beings? ________ Yes __________ No
If yes, please describe the circumstances: _______________________________________________________________________
_________________________________________________________________________________________________________
7. Has this dog ever bitten anyone? ________ Yes __________ No
If yes, please describe the circumstances: _______________________________________________________________________
_________________________________________________________________________________________________________
8. Please provide us with the name and phone number of 2 people who know this dog that we may contact as a reference. who are not related to you.
Ref. #1 – Name: ________________________________________________ Phone # _______________________
Ref. #2 – Name: ________________________________________________ Phone # _______________________
9. Please provide us with the town name of your local Animal Control Officer and their phone number . _________________________________________________________
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 with happy dogs.
10. Circle the adjectives that best describe your dog: - friendly -
protective - shy - noisy - quiet - active - playful - nervous - smart
- affectionate - aggressive - obedient - calm
. Is the dog current on vaccinations? Please list dates of vaccinations.
Rabies:____________ DHLPP____________ Bordatella__________ Lyme’s_____________ Any others?__________
11. Date of last heartworm test: _____________ Neg___ Pos___ Is the dog on heartworm preventative? Yes___ No___
Brand of heartworm medication dog is taking?_____________________ Date of last pill?_________________________
12. Is the dog spayed or neutered?_________________________________
13. Date of last fecal exam for parasites__________________ Results_____________ If positive, was the dog treated?______________________
14. Medications the dog is taking? _______________________________________________________________________________
15. Is the dog housetrained? Yes____ No____ Partly____
If partly, please describe when accidents occur:
_______________________________________________________________________________
16. Are there any behavior problems, if so what are they?
_______________________________________________________________________________
17. Does the dog get along with other dogs?___________ Cats?__________ Other animals?_________________
18. Does the dog like children?_____________________ Are there children in the home?_________ Children’s ages: ___________________
19. What BRAND of dog food is the dog fed?_________________________________
Canned___ Dry___ Semi-Moist___ or a combination_________________________
How much is the dog fed?_____________ How often is the dog fed?__________
Are there any specific feeding instructions you wish to share with the new owner? _____________________________________________________________
20. Where does the dog sleep? _______________________________________________________________________________
21. Is the dog allowed on the furniture?_________ Is the dog crate trained?_______________
22. Where did you keep the dog during the day? _____________________ At night? ________________________
23. How does the dog react to being left alone?
_______________________________________________________________________________
24. Is it afraid of anything in particular? (thunder, men, brooms, etc.)
_______________________________________________________________________________
25. Describe any training the dog has had, or tricks it has learned:
_______________________________________________________________________________
26. Does the dog have any health problems? Yes ___ No ___
If yes, please describe: _______________________________________________________________________________
27. Does the dog like riding in the car?______________________________
28. What is the dogs favorite toys or play thing ? ___________________________________________________________________________________
Favorite pastime? _______________________________________________________________________________
29. What does the dog like? ___________________________________________________________________________
30. What does the dog dislike? __________________________________________________________________________
31. Does the dog jump kiddie gates or fences? __________ If yes, how high does the dog jump:_________________
32. Is the dog a digger? Yes ____ No ____
33. Is there anything else you can share that is special, unusual, or endearing about your dog that would help the new owner?
_______________________________________________________________________________
_______________________________________________________________________________
34. Are there things you think a new owner ought to be aware of?
_________________________________________________________________________________
____________________________________________________________________________
When surrendering the dog please bring the following items if you have them:
Toys, bowls, crate, blankets, beds, food and any other items you may have so it will make it easier
for the dog to adjust to his/her new home.
Please send digital
pictures of the dog you wish to surrender to
boxerangelsdirectors@yahoo.com
or to our Intake Coordinator Kristi at
boxerangelkristine@yahoo.com
or you can mail printed pictures to Boxer Angels Rescue, PO Box 543, N.
Bellmore, NY 11710
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