Home Counties Boxer Welfare

  
 

(Registered Charity No. 1006246)

  
     
  I/We Mr/Mrs/Miss

......................................................................................

 hereby accept the dog/bitch  
               Named:

(.....................................................................................)

    
     
  From HOME COUNTIES BOXER WELFARE, subject to the Conditions of Adoption, which I/we have read and to which
 I/we agree.		    
     
  Signature....................................................................









Handling charge/Donation:£.............CASH/CHEQUE
 		 Address.......................................................................................

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......................................................................................................

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..............................Post Code......................................................

Telephone number....................................................................
 		  
  Date....................................  Signature of Witness .................................................................................................................  
 
When completed, this form should be returned to:		  
    Secretary & Co-ordinator:
Miss Ann Podmore
Farthing Ridge
89a High Street South
Stewkley, Nr Leighton Buzzard
Bedfordshire, LU7 0HU
e-mail: dallgerrypodmore@tiscali.co.uk		  
     
 

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  (For official use only)  
 
Dog/bitch .......................


Age.............................
Colour..................................................		  
   
Previous owner/s




 		 ............................................................................................................................

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Inoculation Certificate


 		 Yes/No     Vet ....................................................................................................

                      .......................................................................................................
 
Pedigree Certificate

 		 Yes/No     Sire ...................................................................................................

                  Dam ..................................................................................................
Insurance Certificate
 		 Yes/No
 
Microchipped
 		 Yes/No
 
 
  Breeder ..............................................................................................................................................................................
 		  
  Reason for parting .........................................................................................................................................................

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