assessment

April, 2024

The Assessment Form For The Re-homing of Your Boxer

PLEASE READ BEFORE SUBMITTING THIS QUESTIONNAIRE

IMPORTANT: If your dog has bitten or shown aggression towards a
person or any animal, it may not be possible for us to rehome your dog.

At the end of the questionnaire, you will be asked to confirm you are aware you
are signing THE DANGEROUS DOGS ACT, 1991 (amended 1997 and May, 2014).

The Act states that giving any false or misleading information is a Criminal
Offence and that it may result in a prosecution being brought against you.

PLEASE NOTE: If you need to rehome more than
one Boxer, we would require a form for each dog.

Questions marked with # are required please

From 25th May, 2018, the General Data Protection Regulation (GDPR) became law
which means that we are only able to contact you if we have your permission.

# Please tell us how we may contact you by indicating one or more of the methods below.

# Your title, please

# Your other title, please

# Your full name, please

Your FULL address, please,

House Name

# House Number

# Street

# Town

City

# County

# Postcode

# Home phone number

# Mobile number

# Your email address, please

# Please confirm your email address

# What is your boxer’s name, please

# Are you the registered keeper?

Yes No

# Do you know your boxer's date of birth?

Yes No

# What is your boxer’s date of birth?

# What colour is your boxer?

Red White Brindle Deaf White

# Do you have a dog or bitch?

Entire Dog Neutered Dog Entire Bitch Spayed Bitch

# Has your bitch ever had a season?

Yes No Don’t know

# Do you know the date of her last season?

# Are the vaccinations up to date?

Yes No Don’t know

# Do you know the date of the last vaccination?

# Is your boxer micro-chipped?

Yes No Don’t know

# Please insert the 15 digit number and press ENTER on your keypad.

# Has your boxer ever been wormed?

Yes No Don’t know

# Do you know the date of the last worming?

# Does your boxer have any health or allergy problems?

Yes No None known

# Please give details of your boxer’s health or allergy problems along with any medication given.

Maximum 500 characters

# Is your boxer fully housetrained?

Yes No

# Is your boxer good with all adults?

Yes No

# Is your boxer good with all children?

No All children Only older children

# Is your boxer good with other dogs?

Good with all dogs Good with small dogs Not good with small dogs Not good with any dogs

# Has your boxer ever lived with a cat or any other small pets?

Has previously lived with a cat Has never lived with a cat Has lived with other small pets Has never lived with any small pets

# What is your boxer's temperament?

Calm Bouncy Boisterous Excitable

# What is your boxer's obedience level?

Very obedient Obedient sometimes Needs more training

# How well does your boxer walk on the lead?

Walks easily beside you Pulls on the lead Easily distracted

# How good is your boxer’s recall?

Recall is excellent Needs more training Has “selective hearing" Has never been off the lead

# How well does your boxer travel well in a car?

Good for short distances Loves the car Good for any distance Hates the car

# Is your boxer able to jump fences?

No Has never tried to jump Can jump low fences Can jump high fences

# Is your boxer possessive with food or toys?

Possessive with food Not possessive with food Possessive with toys Not possessive with toys

# Can your boxer be left alone?

Yes No

# Is your boxer destructive when left?

Yes No

# Can your boxer be left in a cage?

Yes No Has never been caged

# Has your boxer ever bitten or been aggressive?

Has never bitten Has never been aggressive Has bitten a child Been aggressive towards a child Has bitten an adult been aggressive towards an adult Has bitten another animal been aggressive towards another animal

# Can you give full details of any biting and / or aggressive behaviour, please.

Maximum 500 Characters

# Can you please give us the reason why you need to re-home your boxer.

Maximum 500 Characters

# Is there any other information that you feel may be helpful to finding the right home?

Yes No

Any other information about your boxer not covered by the previous questions?

Maximum 500 Characters

# Do you have a Vet?

Yes No

# What is the name of the Veterinary Practice?

House name

# House number

# Street

# Town

City

# County

# The Postcode

# The Phone Number

# Do we have permission to approach your vet for any further information?

Yes No

# Please confirm that the information given on this questionnaire is truthful and correct

I confirm that the information that I have given above is truthful and correct

PLEASE BE AWARE THAT BY COMPLETING THIS ASSESSMENT FORM THAT YOU
ARE SIGNING THE DANGEROUS DOGS ACT 1991(Amended 1997 and May, 2014).
THE ACT STATES THAT THE GIVING OF ANY FALSE OR MISLEADING INFORMATION
COULD LEAD TO CRIMINAL PROCEEDINGS BEING BROUGHT AGAINST YOU.

Please also confirm that you are fully aware that by submitting this questionnaire
that you are signing The Dangerous Dogs Act 1991(amended 1997 and May, 2014)

# I confirm that I am aware that I am signing the dangerous dogs act 1991/1997/2014.

I confirm that I am signing The Dangerous Dogs Act 1991 (Amended, 1997 and May, 2014)

Please type the code into the box below to reveal the “SEND” button

TVBRhuey45

# the code is case sensitive #