Adoption Application
About You:
Name with Home Area code: eg: Jane Doe (123)
Email: (name@domain.com)
Home Telephone: (include area code) Work Telephone: (include area code) FAX: (include area code) Cell:(include area code)
Address: City/Town: State/Prov.: Zip Code: We work only within Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont. Applications submitted from outside these states cannot be considered.
How long employed with current employer?
Spouse/Significant Other's Name:
Spouse/Significant Other's Occupation:
List any Humane Societies, Organizations, Breed or Training Clubs you are associated with:
How did you hear about Boxer Rescue?
Are you currently working with any other Boxer Rescues? -- Please choose one -- Yes No If yes, please provide the name, phone number and email address so we may collaborate our efforts:
About Your Home:
1. Do you live in: -- Please choose one -- House Apartment Condo Trailer Other
2. Do you own or rent your home? -- Please choose one -- Own Rent 2b. If you rent, name, phone number and address of landlord
3. How long at current address (years/months)
3b. Are you planning on moving within the next year? -- Please choose one -- Yes No 3c. If yes, please explain
5. Is your yard fenced in securely for a dog? -- Please choose one -- Yes No If yes, is dog yard: -- Please choose one -- Fully fenced Partially fenced in Please provide specific measurements
6. Do you have a cable or kennel run? -- Please choose one -- Yes No If yes, please describe cable run and provide kennel run measurements:
6b. If no to fenced yard, cable or kennel run, how will exercise/toilet be handled?
6c. Do your neighbors have pets? This includes people next door, across the street, and in your immediate surroundings such as your block. -- Please choose one -- Yes No If yes, please provide information as to type including whether it is a cat or dog, breed, size, temperament, if it is an outside or inside dog, etc.
7. Which best describes your home? -- Please choose one -- House in the country House in the suburbs Townhouse House in the city Apartment Other If other, please explain
What are the requirements of dog ownership in your community? (i.e., licensing, rabies, leash laws, and number of dogs you may legally have)
8. How many adults in house? -- Please choose one -- One Two Three Four Five or more Please list names and ages of each adult in your home:
Any children in the home? -- Please choose one -- None One Two Three Four Five or more Please list names and ages of each child in your home:
Planning on children in future? Within year? two years? three years or more?
Is there anyone in your home with animal related allergies? If so, please explain:
Is there anyone in your home with a disability or special needs that we should be made aware of their condition?
About Your Other Pets:
9. Do you own any other dogs? -- Please choose one -- Yes No
Are they spayed or neutered? -- Please choose one -- Yes No If not, why?
10. Any other pets/livestock? -- Please choose one -- Yes No
11. List names, breed, age and sex of each of your current pets (cats, dogs, etc.): Pet #1 Pet #2
12. How many dogs have you owned in the last 5 years? -- Please choose one -- None One Two Three Four Five or more
13. What happened to your last dog? -- Please choose one -- Still Own Lost Stolen Given Away Died Other Please explain circumstances for above and please provide specifics, including name of dog, breed, and any other pertinent specifics: If your last dog was given away, please indicate the name and address of the person to whom the dog now belongs:
Are all of your animals (dogs and cats) current on all vaccinations? -- Please choose one -- Yes No If not, why?
Are all of your animals (dogs and cats) on heartworm preventative? -- Please choose one -- Yes No What type? (please specify)
How have you educated yourself about the Boxer breed? Please specify.
17. List your life activities in which you would enjoy including your dog:
Would you accept a boxer mix? -- Please choose one -- Yes No
18. Kind of dog do you want? Sex: -- Please choose one -- Male Female Doesn't Matter Age: -- Please choose one -- Under 1 Year 1-3 Years 4-6 Years Over 6 Years Doesn't Matter
Color (please check one for 1st choice, one for 2nd choice): First choice: Fawn Brindle White/Check Second choice: Fawn Brindle White/Check
Is there a color you would not want and why?
Ears: -- Please choose one -- Cropped Natural Doesn't Matter
Tail: -- Please choose one -- Docked Long Doesn't Matter
Did you see a particular dog/dogs on the website that interested you? -- Please choose one -- Yes No If yes, which one: 1st Choice: 2nd: 3rd:
A. Would you consider a special needs dog, such as one that requires daily medication or one that is deaf? -- Please choose one -- Yes No Maybe
B. Would you consider adopting a dog with a disability? -- Please choose one -- Yes No Maybe
C. Would you consider adopting more than one dog? -- Please choose one -- Yes No Maybe
Would you crop ears and dock tail if they were not already done? Ears: Yes No Tail:Yes No
What is the oldest age you would consider?
About Living Environment:
19. Where will dog spend most of each day? -- Please choose one -- Indoors Outdoors
If indoors: -- Please choose one -- N/A as dog will be outside Crate Basement/Garage Free run of house Limited area of house Other Please provide specifics on your answer provided above: If outdoors: N/A as dog will be indoors Fenced Yard Cable Run Tethered Kennel Outside Shelter Other Please provide specifics on your answer provided above:
Who will be in charge of the daily care of the dog?
Who will care for your pet during vacations?
If you don't usually use a crate, will you be willing to use one if you get a dog that is used to being crated? Please choose one Yes No
Is someone home at all times or will the dog need to be alone for a portion of the day? -- Please choose one -- Someone home at all times Alone during workday Alone during worknight Taken out at lunch I use Doggie Daycare If someone takes dog out during day, is it: -- Please choose one -- Applicant or family member Family member out of home Neighborhood Child Please explain your choice above and please be specific by describing your work hours, etc.:
What will you do if your dog is destructive while left alone?
20. Where will dog sleep? (Please check all that apply) Crate Dog Bed Family Member's Bed Basement Garage Fenced Yard Outside Shelter Kennel Dog House Please provide specifics as to dog's sleeping environment to support your answers above:
21. How would you exercise the dog?
22. What is your definition of disciplining a dog? Please provide examples:
Do you want a dog trained to stay off the furniture? -- Please choose one -- Yes No
Have you ever obedience trained a dog before? -- Please choose one -- Yes No
Are you willing to attend obedience classes with your dog? -- Please choose one -- Yes No
What are your thoughts on Obedience training?
23. How much do you think it would cost to feed the dog on a weekly basis? (Please explain)
What kind of dog food would you feed the dog? -- Please choose one -- Dry dog food Wet canned food Home cooked dog food BARF (Bones and Raw Food) Diet Other If other (please specify):
What would the dog's eating schedule be? -- Please choose one -- Once a day Twice a day Free feeder Other
24. What would you consider a realistic cost to properly care for a dog for one year? (Please explain)
26. Who is your veterinarian:
Vet's Address
Vet's Telephone (include area code)
28. Do you agree to the following: Return dog to Boxer Rescue if you can no longer keep or care for dog at any time in the future? -- Please choose one -- Yes No Allow Boxer Rescue agent to visit your home prior to adoption? -- Please choose one -- Yes No
29. Why have you chosen to get a boxer through rescue?
Please provide 3 personal references (not related to you):
Anything else that you think might help us find the right Boxer for you: None
Your Signature (Type your Full Name)
Today's Date
When you click on the buttons below, you are stating your agreement and compliance to our application process.
By checking this box, you have indicated that this is a valid and legal substitution for your written signature on this legal document titled "Boxer Rescue Application". By checking this box, you are stating that you are financially and physically able to care for this dog. You understand that proper food and veterinary care can be costly, and you are able to meet these requirements. By checking this box, you understand that if the information contained herein is found to be false, your application can be refused or said dog adopted shall be relinquished to Boxer Rescue without a refund of monies paid. By checking this box, you understand that should you adopt from Boxer Rescue, the $375.00 adoption fee goes toward the cost of caring for all of the rescue dogs, and that this fee is non-refundable. Please hit submit button only once. IMPORTANT: Print out a copy of your application in case you experience any computer problems. If you get an error message after you hit the submit button, try refreshing/reloading the page. If that doesn't work, hit the back button on your browser, then click the submit button again.