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Surrendering a Boxer to FBR

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I have read all the information on this page: *
You must confirm that you have read the above.You must confirm that you have read the above.
First Name: * A value is required. Last Name: * A value is required.  
Street Address: * A value is required. Address Line 2:
City: * A value is required. State: * A value is required. Zip: * A value is required.Invalid format.  
Phone Number: * A value is required.Invalid format.  xxx-xxx-xxxx Cell Phone Number: Invalid format.  xxx-xxx-xxxx
Your Boxer's Name: * A value is required. Email: Invalid format.
Boxer's Age: * A value is required. Boxer's Gender: * Please select an item.  
Is the Boxer spayed or neutered? * Please select an item.  
Boxer's Weight: * A value is required. Boxer's Color: * Please select an item.
Natural or cropped ears?* Please select an item. Is tail docked or natural? * Please select an item.
Where did you get this Boxer dog? * Please select an item.  
How long have you lived with this Boxer? * A value is required.  
Is the Boxer up to date on vaccines including rabies? * Please select an item.
When were they last given? * A value is required.    
Is Boxer up to date on flea and tick prevention? *
Please make a selection.
 
If no, when was flea and tick prevention last administered?  
Is Boxer up to date on heartworm preventative? *
Please make a selection.
 
If no, when was heartworm preventative last given?  
Do you have vet records available for this Boxer? *
Please make a selection.
Does this Boxer have a microchip? *
Please make a selection.
 
If yes, what is this microchip number and brand?
Does this Boxer have any health concerns we should be aware of (such as thyroid issues, food allergies, tumors, seizures, daily medications, needed surgeries, broken bones, malnourished, special diet, etc...)? *
Please make a selection.
Please explain in detail. If no, type "Not Applicable." * A value is required.
Veterinarian's Name: * A value is required. Clinic's Name: * A value is required.
Street Address: * A value is required. Address Line 2:
Vet's City: * A value is required. State: * A value is required. Vets Phone: * A value is required.
Please explain any behavioral or aggression issues. If none, type "Not applicable." *
A value is required.
Does your Boxer suffer from separation anxiety? *
Please make a selection.
 
If yes, please explain what happens when you leave.
Does your Boxer display food aggression? *
Please make a selection.
 
If yes, please explain:  
Does your Boxer live inside or outside? *
Please make a selection.
 
Is your Boxer housetrained? *
Please make a selection.
   
Is your Boxer crate trained? *
Please make a selection.
 
Is your Boxer leash trained? *
Please make a selection.
Is your Boxer obedience trained (knows basic commands like Sit, Come, Stay, Down, Heel, etc...) *
Please make a selection.
How does your Boxer do with other dogs? *
Please make a selection.
Does your Boxer like cats? *
Please make a selection.
   
Does your Boxer like kids? *
Please make a selection.
 
Please list the other pets your Boxer lives with: * A value is required.  
Please list the ages of the children you Boxer lives with: * A value is required.
How does your Boxer interact with men? * A value is required.  
How does your Boxer interact with women? * A value is required.  
To your knowledge, has this dog ever been exposed to an abusive home or neglectful situation? *
Please make a selection.
If yes, please explain:  
Has this Boxer ever bitten anyone? *
Please make a selection.
   
Please explain the circumstances in detail. If the dog has never bitten anyone, please type "Not Applicable."
* A value is required.    
Is this Boxer aggressive towards other dogs or people? If so, please explain in detail. If not, type "Not Applicable"
* A value is required.    
Why are you giving up your Boxer?      
* A value is required.    
When does your Boxer need a new home? PLEASE NOTE: FBR, Inc. operates on a foster home-only basis. We do not have a kennel or boarding location where all the dogs stay. We will need to locate a foster home for your dog prior to bringing him into the program. Please allow for a reasonable amount of time for us to locate a foster home. Very rarely can we take a dog the same day this form is completed. * A value is required.Please click to choose a date.
Additional Comments:  
I understand that by filling out this form, FBR, Inc. is not obligated to accept my Boxer into their rescue program. I understand that an FBR representative will contact me within one week to discuss the information on this form. I understand that FBR may have suggestions for me or an alternative way to help, such as posting my dog's information on the Owner Surrender page. I understand that if my Boxer is determined to be a good candidate for an available FBR foster home, I will relinquish all claim to my Boxer and allow FBR, Inc. to place him or her into their adoption program.
Please make a selection.Please select Yes to confirm the above is true.   All of the information I provided is true to the best of my knowledge.  
By clicking on "Submit" you agree to the above statements
and that you have filled out this form to the best of your knowledge.