Surrender Form

Owner Surrender Form

Surrenderer's Info

First Name(Required)

Last Name(Required)

Street address(Required)

City(Required)

State(Required)

County(Required)

Zip(Required)

Phone(Required)

Email(Required)

Are you the legal owner of the boxer you are wanting to surrender?(Required)

Yes

Dog's Info

Name of the Boxer(Required)

Current Age of the Boxer(Required)

Is the Boxer a male or female?(Required)

Male

Female

Is the Boxer spayed or neutered?(Required)

Yes

Not Sure

How much does the Boxer weigh?

What is the color of your Boxer?(Required)

Are the ears natural or cropped?(Required)

Is the tail docked or natural?(Required)

Is the boxer microchipped?(Required)

Yes

Not Sure

If yes, please provide the microchip number and chip company name.(Required)

Where did you get this boxer dog?(Required)

How long have you had this boxer?(Required)

Dog's Health Info

Is the Boxer up-to-date with all vaccines including rabies?(Required)

Date of last Rabies vaccine?

Is Boxer currently receiving heartworm preventative?(Required)

Yes

If yes, please list the brand and date of last dose.

Is Boxer currently on flea/tick preventative?(Required)

Yes

Do you have vet records available for this boxer?(Required)

List your veterinarian name, if you don’t have one write N/A(Required)

Veterinarian's Phone

Please list any medical conditions or concerns this Boxer has or had that we should be aware of (such as thyroid problems, allergies, seizures, tumors, daily medications, surgeries, broken bones, special diet, heart conditions etc...)? Please explain in detail or type "NONE."(Required)

Dog's Character Profile

Does your Boxer have separation anxiety?(Required)

Yes

Please explain(Required)

Does your Boxer display food or toy aggression?(Required)

Yes

Please explain(Required)

Where does your Boxer live?(Required)

Inside

Outside

Is your Boxer house/potty trained?(Required)

Yes

Is your Boxer crate trained?(Required)

Is your Boxer leash trained?(Required)

Is your Boxer obedience trained (knows basic commands like "Sit", "Come", "Stay", "Down", "Heel", etc...)?(Required)

How is your boxer with other dogs? Check ALL that apply:(Required)

Likes ALL dogs regardless of size or gender

Prefers Female dogs Only

Prefers Male dogs Only

Prefers large dogs Only

Prefers small dogs only

Does NOT like any other dogs

Unsure how boxer would be with other dogs

Does the Boxer like cats?(Required)

Does the Boxer do well with children? Check ALL that apply(Required)

Boxer good with young kids (under 8yrs old)

Boxer good with older kids (8 yrs and older)

No, my Boxer prefers a home with no kids

I do not know how my Boxer would be with kids

If your boxer currently lives with children or has spent time around children, please list the ages of the children. If not applicable write “N/A”(Required)

Does the Boxer currently live with other pets?(Required)

Yes

Does your Boxer currently live with children?(Required)

Yes

Has this Boxer ever nipped, snapped at or bitten anyone?(Required)

Yes

Please explain(Required)

Has this Boxer shown aggression towards other dogs or people?(Required)

Yes

Please explain(Required)

Why are you needing to surrender your Boxer?(Required)

What is the time-frame for finding a new home for your boxer? (PLEASE NOTE: CBR is a foster based rescue. We do not have a shelter or boarding facility, therefore, we need a reasonable amount of time to find a foster home best suited for any incoming dog to our rescue)(Required)

Please provide any other information you think we should know about your boxer.

ATTACH PHOTO 1- Full Front View of your boxer (Face/head)

Max. file size: 256 MB.

ATTACH PHOTO 2 – Full Standing Side View of your boxer

Max. file size: 256 MB.

Consent

I understand that by submitting this form, Coastal Boxer Rescue of Florida Inc. (CBR) is under no obligation to accept my boxer into their rescue program. I understand that a CBR representative will contact me to discuss the information on this form. I understand that if my Boxer is considered a good candidate for an available CBR foster home, I will relinquish all claim to my boxer and allow CBR to place him or her into their adoption program.(Required)

Yes, I understand and agree to the below statement

Today's Date

MM slash DD slash YYYY

By Clicking on “SUBMIT” you agree to the above statements and that you have filled out this form truthfully and to the best of your knowledge.

Phone

This field is for validation purposes and should be left unchanged.

Coastal Boxer Rescue utilizes the online donation services provided by PayPal. You do not need to have a paypal account in order to donate through paypal. You can choose to pay through your PayPal account or with your credit or debit card.

If you prefer to mail in your donation, checks can be mailed to:

Coastal Boxer Rescue of Florida
P.O. Box 121381
W. Melbourne Fl. 32912-1381.

* Please make checks payable to: Coastal Boxer Rescue of Florida Inc.