Wigglin Home Boxer Rescue Owner Surrender Form

Rehome Your Boxer

If you are needing to surrender your Boxer to Wigglin' Home Boxer Rescue please complete the following questionnaire and upload a minimum of two photos and any medical records such as vaccination records, spay/neuter, and any other veterinary records you may have. A representative of WHBR will be in touch with you within 48 hours. If this is an emergency please call us directly at (360)723-0219.

****If you live in any other state besides WA, OR, ID, CA, or MT please call us at the number above prior to submitting this form.

Full Name*

First NameLast Name

Primary Phone Number*

Area CodePhone Number

Secondary Phone Number*

Area CodePhone Number

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Dog's Name*

Purebred*

YesNo

If you know what breed(s) they are a mixed with please list:

Age of Dog?*

Weight?*

Sex?*

MaleFemale

Color*

Ears*

CroppedNatural

Tail*

DockedNatural

Spayed/Neutered?*

YesNoUnsure

Current on Rabies Shot?*

YesNoUnsure

Current on Distemper/Parvo Shot?*

YesNoUnsure

Heart worm tested in last year?*

YesNoUnsure

Received heartworm preventiative this year?*

YesNoUnsure

Is your dog microchipped?*

YesNoUnsure

Has dog ever had puppies?*

YesNoUnsure

Any current medical problems?*

YesNoUnsure

Please list current medical problems:*

Name of Current Vet:*

Vet's Number*

Area CodePhone Number

Brand of current dog food?*

Feedings per day?*

How much?*

Where did you get your Boxer?*

How long have you had your Boxer?*

How many owners has this dog had?*

House Broken?*

YesNo

Jump Fence?*

YesNoUnsure

Crate Trained?*

YesNoUnsure

Digger?*

YesNo

Barker?*

YesNoVery Little

Leash Trained?*

YesNoVery Little

Obedience Trained?*

YesNo

Dog Aggressive?*

YesNoUnsure

Please describe how your dog interacts with other dogs.*

Is your dog good with other dogs?*

YesNoUnsure

What commands does you Boxer know?*

Any other dogs in your home?*

YesNo

Please list breed(s), sex, age, and if spayed or neutered:

Is your Boxer good with cats?*

YesNo

Do you have any cats in your home?*

YesNo

Is your Boxer good with kids under 4?*

YesNo

Is your Boxer good with kids over 4?*

YesNo

Are there kids currently in your home?*

YesNo

Please list the ages of your children:

Has your dog ever bitten a human?*

YesNoUnsure

Please describe what happened in detail:

Has your dog ever bitten another animal?*

YesNoUnsure

Please describe what happened in detail:

Where does your dog stay when you are not home?*

On average, how long is your dog home alone?*

Where does your dog sleep at night?*

Is your Boxer allowed inside?*

YesNo

Does your Boxer have a tendancy to run off?*

YesNo

Please Explain

Is your dog used to a fenced yard?*

YesNo

Is your dog destructive when left alone?*

YesNo

Please Explain:

Is your dog afraid of anything?*

YesNo

Please describe:

For what reasons are you considering surrendering your Boxer?*

Please provide additional information we should know about your dog:*

Will your Boxer be coming with any supplies?

collar, leash, crate, food, toys

Please upload at least two photos:

Upload Pictures

Please upload any vet records you have:

Upload Files

It is understood that Wigglin' Home Boxer 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 Wigglin' Home Boxer Rescue are volunteers.

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 to Wigglin' Home Boxer 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.

I hereby relinquish all rights of the aboved named BOXER, to Wigglin' Home Boxer 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

Signature

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

A Wigglin' Home Boxer 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: (360) 723-0219

email: wigglinhomeboxerrescue@gmail.com

Visit us at:wigglinhomeboxerrescue.org

Wigglin' Home Boxer Rescue Owner Surrender Form

Dog Info