Animal Surrender Form

Shelters and rescue centers use this extensive form to gather a dog's full history before intake, covering behavior, health, habits, and how it gets along with other people and animals.

Use this template

In the Claude connectors directory

Name

First Name

Last Name

Phone

Address

Street Address

City

State / Province

ZIP / Postal Code

When do you need to surrender the boxer?

Dog's Name

Sex

Male Female

Age

Is the boxer purebred or mixed breed?

Purebred Mixed breed

Tail

Docked Natural

How long have you had the boxer?

Where did you get the boxer?

Why are you surrendering the boxer?

What other animals did the boxer live with?

Dogs Cats Other pets None

Comments on answers above

How does the boxer usually react when an unfamiliar person approaches or enters the yard or house?

Is the boxer housetrained?

Yes No Partially

How does the boxer let you know they need to go out?

Where does the boxer spend the majority of their time?

Indoors Outdoors Both

How many hours a day is the boxer left alone without a human?

0-2 hours 3-5 hours 6-8 hours 9+ hours

When left alone, is he/she...

Calm Anxious Destructive Other

When left alone, does boxer usually show any of the following behaviors?

Barking Chewing Pacing None

When the boxer plays, do they typically...

Fetch Tug-of-war Chase Roughhouse

What toys does the boxer like?

Balls Chew toys Ropes Squeaky toys

What games does the boxer like?

Fetch Tug-of-war Hide-and-seek Chase

Is the boxer scared of anything?

Yes No

If yes, please explain

Please tell us the boxer's bad habits

Is the boxer allowed on furniture?

Yes No

Where does the boxer usually sleep at overnight?

Crate Dog bed Owner's bed Floor

What commands does the boxer know?

Sit Stay Come Down

Describe the boxer's leash skills

Describe the boxer's reaction if a person or other dog gets near or attempts to take food he is eating

Describe the boxer's reaction if a person or other dog attempts to take a toy they are playing with

Describe the boxer's reaction if a person or other dog attempts to take a bone or other treat they have

Describe the boxer's reaction if touched when sleeping

Does the boxer have problems riding in the car?

Yes No

If yes, please explain

Has the boxer escaped your property 2 or more times in the last 6 months?

Yes No

If yes, please explain

Has the boxer ever attacked or bitten a person?

Yes No

If yes, please explain

Has the boxer ever attacked or bitten another dog?

Yes No

If yes, please explain

Has the boxer ever attacked or bitten a cat?

Yes No

If yes, please explain

Has the boxer ever attacked or bitten farm animals? (chickens, horses, cows, goats, pigs, sheep, etc.)

Yes No

If yes, please explain

Please list all veterinarians that have seen the boxer, including address and phone number

Does the boxer see a veterinarian at least once a year?

Yes No

Is the boxer spayed/neutered?

Yes No

What vaccinations has the boxer received?

Rabies Distemper Parvovirus Bordetella

Are vaccinations current?

Yes No

Has the boxer been tested for heartworm?

Yes No

If yes, what were the test results?

Is the boxer taking heartworm preventative?

Yes No

If yes, when is the next dose due?

Is the boxer microchipped?

Yes No

Does the boxer have to be muzzled at the veterinarian's?

Yes No

Does the boxer have any past or present health problems?

Yes No

If yes, please describe

Is the boxer currently taking any medication?

Yes No

If yes, please list medications

What type of food does the boxer eat?

Dry food Wet food Raw diet Homemade food

How many times a day is the boxer fed?

Once Twice Three or more times

How much is fed per feeding?

Less than a cup One cup Two cups More than two cups

Does the boxer get treats?

Yes No

If yes, what treats does the boxer like?

Please feel free to tell us any other information about the boxer you feel is important

Please upload a full body picture of the boxer

Max 10 MB per file

Please upload an up-close head shot of the boxer

Max 10 MB per file

Please upload any records you have for the boxer

Max 10 MB per file

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