Lone Star Boxer Rescue P.O. Box 541286
Houston, Texas 77254-1286
281.251.6179 Fax

Name:

Phone#:

Alt Phone#:

Email Address:

Area of town:

Dog’s name:

Age:

Color: Fawn Brindle White

Ears: Floppy Clipped

Tail: Natural Docked

Does the dog have any known medical issue that requires immediate attention?

If yes, please explain:

Is this your personal dog?

If so, please answer the following:

Is the dog spayed/neutered? Y N

Is the dog current on vaccines? Y N

Is the dog on heartworm preventative Y N

Vet name:

Vet phone number:

Please explain why the dog is being given up:

Name, address and telephone number of the Pet Shop, breeder or person you got the dog from:

If the dog is a stray, where was it found (approximate location)?:

How long have you had the dog?

Have you taken the dog to a vet to be scanned for a micro-chip (at no cost)?

Does the dog get along with other dogs? Y N Don’t know

Does the dog do okay with cats? Y N Don’t know

Is the dog good with children? Y N Don’t know

(If so what ages?)

Is the dog house trained? Y N Don’t know

Is the dog crate trained? Y N Don’t know

Where does the dog stay during the day?

Where does the dog sleep at night?

How does the dog do when left alone?

What does the dog like?

What does the dog dislike?

Does the like riding in the car?

Can the dog jump fences? If so, please indicate height of fence it can jump:

Does the dog have any behavior problems? Y N

If so, please explain:

Can you foster the dog until placed?

If unable to foster, can you sponsor boarding at rescue rates?

Can you sponsor the dog’s medical treatment?

How long can you keep the dog?

Please understand that Lone Star Boxer Rescue is a non-profit 501 (c) 3 organization and is 100% volunteer based. We do not have a “shelter”. The dogs in our program are either boarded at a local boarding facility or in one of our few foster homes.

*A minimum amount of $50.00 is required before Lone Star Boxer Rescue will accept a surrendered dog*

A Lone Star Boxer Rescue representative will contact you upon receipt of the completed questionnaire.

The answers you provide will help the representatives of LSBR find a “Forever Home” for this dog. Please email the entire form to or fax to 281.251.6179.

Thank you.

Lone Star Boxer Rescue P.O. Box 541286 Houston, TX 77254-1286 Phone: 713.464.1381 Fax: 281.251.6179