Green Acres Boxer Rescue of Wisconsin

Pre-Surrender Form

Owner Information

Name(s) *

Phone #

Street Address

City/State/Zip

Other phone # (if applicable)

Information About Your Boxer

Name of Dog

Age

Veterinary Care Status

Date of Last Heartworm Test

Name of Veterinary Clinic

Where Did You Obtain This Dog?

Name of Breeder

Name of Humane Society

Obtained via Other Means

Have you contacted them to return the dog?

How long have you had the dog?

Is the dog good with kids?

Is the dog good with cats?

Is the dog good with other dogs?

Other Information

Why are you surrendering the dog?

Any medical problems?

Any behavioral problems?

If you need to surrender the dog by a particular date, please provide the date.

Has this dog ever bitten anyone or another dog?

Has this dog ever nipped anyone or another dog?

Has this dog ever snapped at anyone or another dog?

Anything else we should know about the dog?

Please attach a photo.

Photo #1

Photo #2 (if applicable)

Recaptcha *