EmailMe Form - BRLA Owner Surrender Form

Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email *

Home Phone *

### - ### - ####

Cell Phone

### - ### - ####

How did you hear about BRLA? *

Your Boxer's Name *

Your Boxer's Age or D.O.B? *

Your Boxer's Gender *

Spayed or Neutered? *

Color *

Tail *

Ears: *

Where did you get your Boxer? *

How long have you had your Boxer? *

Why do you want to surrender your Boxer? *

Please upload photo(s) of your Boxer *

If you have other pets in the home, please describe (breed, sex & age):

Where does your Boxer spend the majority of their time? *

Housebroken? *

My Boxer's temperment (click all that apply) *

Hold down the CTRL key while selecting multiple options

Added comments on my Boxers temperment

Good with Other Dogs? *

Yes

Some

Most

No

If Good with Dogs (click all that apply)

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Social Skills (click all that apply while holding CTRL key down) *

Added comments: my Boxers's interactions with other dogs

Do you walk you Boxer daily? *

Yes

No

How does your Boxer act on walks *

Added comments on leash walking:

Crate trained? *

How many hours alone each day? *

Good with Children *

If YES with Children, please explain: from living with, visiting etc. and ages of kids involved.

Where does you Boxer sleep? *

What does your Boxer do when left home alone *

Good with Cats *

If YES with cats, please provide details

Is your Boxer Possessive of Toys *

Does you Boxer have food aggression: *

Yes

No

Don't know

Is your Boxer protective of you, your family or your home *

If YES to protective, please explain

Has your Boxer been trained (click all that apply) *

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Commands my Boxer knows (click all that apply)

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My Boxer's Vet

My Boxers health *

Please explain any health concerns in detail.

Are your Boxer's vaccinations current *

Is your Boxer Microchipped *

My Boxer eats this brand of dog food *

Has your Boxer ever bitten anyone? *

If YES to a bite, please explain in detail.

How much time do you have before surrendering your Boxer? *

Comments

I hereby certify: (a) that I am the rightful owner/keeper/caretaker/custodian of the boxer (b) that I have authority to surrender the boxer, (c) that I am willfully surrendering and releasing any and all of my property rights to the boxer, (d) that no other person has a right of ownership to the boxer, (e) that upon surrender the boxer may not be returned to me. I have read and understand the terms of this Surrender From and that the typing of my name here acts as my legal signature *

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