Boykin Spaniel Rescue, Inc.

94 Sunrise Dr.

Eufaula, Al  36027 

334-687-4950

 

Rescue Referral Form

 

Please complete this form and return it to the above address with a $25.00 donation. Donation will only be refunded if the ad is not placed on the website due to refusal by the BSR governing body.

 

Proof of spay/neuter and current vaccinations in the form of vet certificates MUST be included for your dog to be listed on our website. NO EXCEPTIONS.

 

The donation is used to cover operating costs, including the website fees. Checks should be made out to Boykin Spaniel Rescue, Inc. (BSR, Inc.).

 

Please include a current photo of your dog if you have one available. Photos will only be returned if a stamped self-addressed envelope is included. The photo will be used for the purposes of advertising your dog on the website. It is highly recommended to include a photo of your dog.

 

The URL for the BSR website is http://www.boykinrescue.org .

 

We will also provide referrals to you from our network but we are not required to do so. Although we pre-screen prospective adopters, it is your responsibility to screen all parties interested in adopting your dog. Also, see the list of questions you might want to ask – Guidelines for Screening Potential Adopters.

 

We request that when your dog is successfully adopted, you notify us immediately so that we may remove your dog from our list of available Boykin Spaniels, thus saving you any further calls.

 

 

 

I, __________________________________, hereby make available for referrals through Boykin Spaniel Rescue, Inc. a dog named ________________________. I understand that information pertaining to my dog will be posted on the internet at www.boykinrescue.org.

 

I certify that I am the owner of this dog and that the information provided here is true and complete. I hereby forever release, discharge and agree to hold harmless and indemnify the Boykin Spaniel Rescue, Inc. and its volunteers from all claims in connection with the adoption or any other disposition of the above mentioned dog.

 

Read, understood and agreed on this _________ date of ________, 20____.

 

 

____________________________________

Signature of owner

 

Owner’s name_______________________________ Home Phone ___________________

 

Address_____________________________________ Work Phone ___________________

 

City _______________________________ State _____________ Zip _________________

 

Best time to call____________________ Email___________________________________

 

Dog’s name________________________________Age____________months/years

 

Date of Birth if known__________________ Is the dog registered? Yes  No

 

If Yes, list registries _________________________________________________________

 

Color_______________________________ Sex_____________ Weight________________

 

Spayed/Neutered? Yes  No      Housebroken? Yes  No      Crate Trained?  Yes  No

 

Was dog purchased from a breeder?  Yes  No  Breeder’s name_________________________

 

Breeder’s address/phone number_________________________________________________

 

Have you notified breeder of need to find this dog a new home?  Yes  No

 

Was dog purchased from:  Shelter _________ Pet store ________ Other __________________

 

Veterinarian _________________________________________________________________

 

Phone/Address________________________________________________________________

 

Are shots current?  Yes No  Date next rabies due __________  Shots due _________________

 

Heartworm preventative ____________________ Date due next ________________________

 

Does dog have any physical problems?  Yes No    Allergies?  Yes  No

 

Is this dog on any medications?  Yes  No    If unsprayed female, last heat cycle_____________

 

Has the dog had obedience training?  Yes  No   What commands, skills, or tricks does this dog know?___________________________________________________________

 

 

 

 

 

What brand of food do you feed this dog?__________________________________________

Amount fed?_________ How often?___________________________

 

How does your dog spend its days?  Please circle all that apply:  INDOORS    CRATED  BASEMENT    GARAGE    FENCED YARD   LOOSE UNFENCED    TIED OUT   

KENNEL RUN    ALONE ALL DAY     OTHER____________________________

 

How does your dog spend its nights?  Please circle all that apply.  INDOORS     CRATED    SLEEPS ON BED WITH OWNERS    SLEEPS IN OWN BED    BASEMENT    GARAGE    FENCED YARD    LOOSE UNFENCED    TIED OUT    KENNEL RUN   

OTHER________________________________________________

 

How does your dog act around the following?  Other dogs?_________________________

Cats?___________________________Strangers?_________________________________

Children?____________________________________________________

 

How is your dog at:  Walking on lead______________________ Being alone in yard _______________________  Being alone in the house_____________________________

Alone in car____________________________ Riding in car ________________________

Possession of his food________________________________Possession of toys____________________________________

 

Has your dog been raised with or been around children?  Yes  No

If yes, what ages?_______________________________

 

Does your dog have any of the following habits? (circle all that apply) EXCESSIVE BARKING   DIGGING    FENCE JUMPING    DESTRUCTIVE CHEWING    AGGRESSION    SHYNESS    FIGHTING WITH OTHER DOGS    BITING    PLAY NIPPING    GETTING INTO TRASH    OTHER ___________________________________

 

Has your dog ever bitten anyone (please be HONEST!)  Yes   No 

If so, did the wound require medical attention?  Yes No

What happened to cause this event?___________________________________________ ___________________________________________________________________________

 

Does your dog: Growl when you take away food or toys?  Yes  No  Snap at people?  Yes  No  If Yes, when______________________________________________

 

What does your dog like best?______________________________________________________

 

What does he dislike the most?_____________________________________________________

 

Does he have any fears?__________________________________________________________

 

 

 

What is the most appealing thing about your dog?

_____________________________________________________

 

What is your dog’s biggest fault?

_______________________________________________________

 

Why have your chosen to give up your dog?

_______________________________________________

 

 

 

 

 

***Attach vet certificates for proof of spay/neuter and vaccinations. Listing will be refused without this proof.

 

 

Thank you,

 

Boykin Spaniel Rescue, Inc.

94 Sunrise Dr.

Eufaula, Al  36027

334-687-4950

bsr@boykinrescue.org

www.boykinrescue.org