918-860-BOXR (2697)

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Owner Surrender Form

Please complete entire application. Fields marked with * are required.

Your Name: *

Phone Number: *

Email Address: *

Physical Address: *

Main intersection: *

City: *

State: *

Zip Code: *

Where did this boxer come from?:

Surrender Reason:

Dog's Name:

Gender:

Age (DOB if known):

Weight (approximate):

Color:

Compatible with Large Dogs:

Compatible with Small Dogs:

Compatible with Male Dogs:

Compatible with Female Dogs:

Compatible with Cats or Rabbits:

Compatible with Squirrels or Birds:

Compatible with Livestock:

Compatible with Men:

Compatible with Women:

Compatible with Infants:

Compatible with Toddlers:

Compatible with Children:

Compatible with Teens:

Training: Leash Walking
Training: Potty Trained

Level of House Training:

Crate:

Car rides:

Has this boxer had obedience classes?:

This boxer MUST have:

This boxer must NOT have:

This boxer sleeps where:

How is the dog accomodated when left alone without human supervision?:

Date of Spay/Neuter Surgery:

Date of Rabies Vaccine:

Vet office that gave Rabies shot:

Date of multi-pack vaccination (i.e. 5-in-1 or DA2PPv:

Date of Bordatella:

Date of Wormer:

Brand of Wormer:

Date of microchip:

Microchip manufacturer:

Date of Heartworm test:

Vet that did Heartworm Test:

Heartworm test result?

Heartworm Preventative date last given:

Would this boxer be safe without a fence?

Any history, issues, or concerns you need to pass along:

Final notes:

Upload Photo: *
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Mailing Address:
10026-A S. Mingo Rd., Box 269
Tulsa OK 74133

Phone: 918-860-BOXR (2697)
Email: info@tbro.org

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