Online Adoption Application
Email address *
Which Boxer(s) are you interested in *
Your answer
Have you read the profile of the Boxer(s) you are interested in? *
Profile available on Petfinder
Applicant Name *
Your answer
Address/City/State/Zip Code *
Your answer
Cell Phone Number (with area code) *
Your answer
Home Phone Number (with area code) *
Your answer
Occupation/Place of Employment *
Your answer
Work Phone Number *
Your answer
When is the best time to contact you? *
Your answer
Spouse/Partner's Name *
Your answer
Spouse/Partner's Cell Phone *
Your answer
Spouse/Partner's Place of Employment *
Your answer
Spouse/Partner's Work Phone Number *
Your answer
References
You will need to list two (2) personal references below. You may use ONLY one (1) family member as a reference.
Name/Phone Number of Personal Reference 1 *
Your answer
Name/Phone Number of Personal Reference 2 *
Your answer
Name of Your Veterinarian *
Your current veterinarian and future veterinarian if planned.
Your answer
Veterinarian’s Address/City/State/ZIP code *
Your answer
Veterinarian’s Phone Number (with area code) *
Your answer
How many people reside in your home? *
Do you have children in your home? *
If ‘Yes’ to the question above, list number of children and their ages.
Your answer
Who in the home will care for the dog? *
Your answer
Housing
Where do you live? *
Do you own or rent your home? *
If you Rent, have you received the approval of your Landlord to have an animal?
Landlord’s Name and Phone Number (with area code)
Your answer
Is your yard fenced? *
Describe fence type, height(s),and condition *
Your answer
How much time will the dog spend alone during the day? *
Your answer
Where will the dog be kept when you are not home? *
Your answer
Where will the dog be kept when you are home? *
Your answer
Where will the dog sleep? *
Your answer
Pet Section
Do you have pets? *
Pet #1 Name/Breed/Age
Your answer
Is pet #1 spayed or neutered?
Is pet #1 shots/rabies up to date?
Is pet #1 given monthly heartworm preventative?
What heartworm prevention?
Your answer
Pet #2 Name/Breed/Age
Your answer
Is pet #2 spayed or neutered?
Is pet #2 shots/rabies up to date?
Is pet #2 given monthly heartworm preventative?
What heartworm prevention?
Your answer
Pet #3 Name/Breed/Age
Your answer
Is pet #3 spayed or neutered?
Is pet #3 shots/rabies up to date?
Is pet #3 given monthly heartworm preventative?
What heartworm prevention?
Your answer
Pet #4 Name/Breed/Age
Your answer
Is pet #4 shots/rabies up to date?
Is pet #4 shots/rabies up to date?
Is pet #4 given monthly heartworm preventative?
What heartworm prevention?
Your answer
Pet #5 Name/Breed/Age
Your answer
Is pet #5 spayed or neutered?
Is pet #5 shots/rabies up to date?
Is pet #5 given monthly heartworm preventative?
What heartworm prevention?
Your answer
**If you have more then 5 pets list them here including name/breed/age and vetting
Your answer
Have you given up a pet? *
If yes, please explain the circumstances *
Your answer
What happened to past pets? *
Your answer
Have you owned a Boxer? *
What is your experience with Boxers?
Your answer
Why are you interested in adopting a boxer at this time? *
Your answer
What are you looking for in a Boxer? Select all that apply: *
Required
Do you have a color preference for a Boxer? *
Your answer
Describe how you will train the Boxer *
Your answer
Have you applied to other rescues to adopt? *
If applied to other rescues please name.
Do you know there is an adoption fee? *
Do you agree to spay/neuter if the boxer is too young or has a medical condition and can’t have it before adoption? *
Are you planning to stay at your current address? *
If you are moving or move in the future, what will happen to the adopted boxer?
Your answer
Do you agree to provide an annual vet exam, shots and rabies, fecal and heartworm tests, heartworm prevention, and to provide the vetting that this boxer needs? *
Do you agree to keep your boxer on heartworm prevention all year long for the rest of the Boxer's life? *
Do you agree to restrain your boxer in an open vehicle? *
Do you agree to return the Boxer to Boxer Rescue of Texarkana if you can no longer keep it? *
Do you agree to a home visit from a Boxer Rescue of Texarkana representative before adoption? *
What are your thoughts on crate training? *
Your answer
What are your thoughts on obedience training? *
Your answer
How would you handle potty training in the house? *
Your answer
Do you have further comments that might help us place the right Boxer with you?
Your answer
How did you hear about us? *
Your answer
I certify that the information entered on this application is true. If any information is found to be false then this application can be denied. *
Signature (please type full legal name) *
Your answer
Today’s Date (mm/dd/yy) *
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