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.

Owner Information

Full Name

Address

City    State ALAKASAZARCACOCTDEDCFMFLGAGUHIIDILINIAKSKYLAMEMHMDMAMIMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPWPAPRRISCSDTNTXUTVTVIVAWAWVWIWY   Zipcode

-  -		-  -
Home Phone Number		Alternative Phone Number

Email

Please indicate the following information:

Yes, I can keep my dog until re-homed

No, I can not keep my dog until re-homed and the dog needs out by (date)

No, This is an emergency or the dog has urgent medical needs that I can not afford.
     Please explain in detail:
    

Dog Information

Dog's Name     Age/DOB       

Color  Brindle Fawn Reverse Brindle White Other

Gender  male  female
           
Ears cropped floppy

Tail docked  natural

Name, address and telephone number of the Pet Shop, breeder or person you got the dog from:

How long have you owned this dog?

Why is the dog being given up?

What is the name and address of the veterinarian who last treated and vaccinated this dog?

Is the dog current on vaccinations? Please list dates of vaccinations.
Rabies 
DHLPP 
Bordatella
Lyme’s  
Any others? 

Date of last heartworm test       negative  positive

Is the dog on heartworm preventative? yesno
 
Brand of heartworm medication dog is taking?

Date of last pill?
 
Is the dog spayed or neutered?  yesno

Date of last fecal exam for parasites?    Results negative  positive
If positive, was the dog treated?

Medications the dog is taking?

Dog's Personality

The adjectives that best describe your dog

friendly	protective	affectionate
shy	noisy	quiet
active	playful	nervous
smart	aggressive	obedient
calm

Is the dog housetrained? yes  no  partly
If partly, please describe when accidents occur:

Are there any behavior problems, if so what are they?

Does the dog get along with?
 other dogs
 cats 
 other animals 

Does the dog like children? yes  no

Are there children in the home? yes  no
 
What are their ages?

What BRAND of dog food is the dog fed?
 canned
 dry
 semi-moist
 combination

How much and how oftern is the dog fed? 

Are there any specific feeding instructions you wish to share with the new owner?

Where does the dog sleep?

 
Is the dog allowed on the furniture? yes no

Is the dog crate trained? yes  no

Where did you keep the dog during the day? inside  outside

Where did you keep the dog during at night? inside  outside

How does the dog react to being left alone?

Is it afraid of anything in particular? (thunder, men, brooms, etc.)

Describe any training the dog has had, or tricks it has learned:

Does the dog have any health problems? yes  no
If yes, please describe:

Does the dog like riding in the car? yes  no

What is the dogs favorite toy, play thing, or favorite pastime ?

What does the dog like? 

What does the dog dislike?

Does the dog jump kiddie gates or fences? yes  no
If yes, please indicate how high the dog jumps

Is the dog a digger? yes  no
  
Is there anything else you can share that is special, unusual, or endearing about your dog that would help the new owner?

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. In addition, we request a MONETARY donation of $50 to 100 to go toward the food and veterinary care for your dog.

Please Read Carefully

Being the sole owner of the dog described above I hereby forever relinquish all claims to and ownership of said animal to the organization known as “Austin Boxer Rescue” hereinafter referred to as “ABR”. I understand that I cannot reclaim this dog once the dog is in the possession of ABR. It is my intent to surrender to ABR all of my ownership rights and all other interests of any kind pertaining to the dog. I understand that the final decision as to any adoption belongs to ABR. I agree to give ABR the dog’s AKC registration papers, if any, and all medical records available. ABR shall attempt to find the dog a suitable home, but the organization shall not be held responsible for the actions of the adoptive or foster family.  

Signature waiver: I agree that by typing my name below, that I have read and understood the conditions of this contract.
Furthermore I agree to abide by the terms of this contract.

Signature

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