Online Adoption Application

Email address *

Which Boxer(s) are you interested in *

Have you read the description of the Boxer(s) you are interested in? *

Yes

Have you read our Requirements and meet them? *

Yes

Applicant Name *

Physical Address/Mailing Address if different *

City/State/Zip Code *

Cell Phone Number (with area code) *

Home Phone Number (with area code) *

Occupation/Place of Employment *

Work Phone Number *

When is the best time/days to contact you? *

Spouse/Partner's Name *

Spouse/Partner's Cell Phone *

Spouse/Partner's Place of Employment *

Spouse/Partner's Work Phone Number *

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/Best time to contact *

Name/Phone Number of Personal Reference 2/Best time to contact *

Name of Your Veterinarian *

Your current Veterinarian and future Veterinarian if planned. If you don't currently have pets, who is the last Veterinarian you used and what were your Pets name(s)??

Veterinarian’s Address/City/State/ZIP code *

Veterinarian’s Phone Number (with area code) *

How many people reside in your home? *

Other:

Do you have children in your home? *

Yes

If ‘Yes’ to the question above, list number of children and their ages.

Who in the home will care for the dog? *

Housing

Where do you live? *

House

Apartment

Condo

Mobile Home

Military Housing

Other:

Do you own or rent your home? *

Own

Rent

If you Rent, have you received the approval of your Landlord to have an animal?

Yes

Clear selection

Landlord’s Name and Phone Number (with area code)

Is your yard fenced? *

Front Yard Only

Back Yard Only

Both Yards Fenced

Unfenced Yard(s)

No Yard

Other:

Describe fence type, height(s), size of yard fenced in, and condition *

How much time will the dog spend alone during the day? *

Where will the dog be kept when you are not home? *

Where will the dog be kept when you are home? *

Where will the dog sleep? *

Pet Section

Do you have pets? *

Yes

Pet #1 Name/Breed/Age

Is pet #1 spayed or neutered?

Yes

Clear selection

Is pet #1 shots/rabies up to date?

Yes

Clear selection

Is pet #1 given heartworm preventative?

Yes

Clear selection

What heartworm prevention?

Pet #2 Name/Breed/Age

Is pet #2 spayed or neutered?

Yes

Clear selection

Is pet #2 shots/rabies up to date?

Yes

Clear selection

Is pet #2 given heartworm preventative?

Yes

Clear selection

What heartworm prevention?

Pet #3 Name/Breed/Age

Is pet #3 spayed or neutered?

Yes

Clear selection

Is pet #3 shots/rabies up to date?

Yes

Clear selection

Is pet #3 given heartworm preventative?

Yes

Clear selection

What heartworm prevention?

Pet #4 Name/Breed/Age

Is pet #4 shots/rabies up to date?

Yes

Clear selection

Is pet #4 shots/rabies up to date?

Yes

Clear selection

Is pet #4 given heartworm preventative?

Yes

Clear selection

What heartworm prevention?

Pet #5 Name/Breed/Age

Is pet #5 spayed or neutered?

Yes

Clear selection

Is pet #5 shots/rabies up to date?

Yes

Clear selection

Is pet #5 given heartworm preventative?

Yes

Clear selection

What heartworm prevention?

**If you have more then 5 pets list them here including name/breed/age and vetting asked in pets above

Do you have other pets or livestock? Please explain.

Have you given up a pet? *

Yes

If yes, please explain the circumstances *

What happened to past pets? *

Have you owned a Boxer? *

Yes

What is your experience with Boxers? *

Why are you interested in adopting a boxer at this time? *

What are you looking for in a Boxer? Select all that apply: *

Female

Male

Baby

Young

Adult

Senior

Companion

Companion for another pet

Protective

Other:

Required

Do you have a color preference for a Boxer? *

Describe how you will train the Boxer. *

Have you applied to other rescues to adopt? *

Yes

If applied to other rescues, please name the rescue(s).

Do you know there is an adoption fee? *

Yes

Do you agree to spay/neuter if the boxer is too young or has a medical condition and can’t have it before adoption? *

Yes

Are you planning to stay at your current address? *

Yes

If you are moving or move in the future, what will happen to the adopted boxer?

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? *

Yes

Do you agree to keep your boxer on heartworm prevention all year long for the rest of the Boxer's life? *

Yes

Do you agree to not transport your boxer in an open vehicle? *

Yes

Do you agree to return the Boxer to Boxer Rescue of Texarkana if you can no longer keep it? *

Yes

Do you agree to a home visit from a Boxer Rescue of Texarkana representative before adoption? *

Yes

Do you crate your dogs when not home? What are you thoughts on crate training? *

Do you have doggie door? *

Yes

When do you use the doggie door?

What are your thoughts on obedience training? *

How would you handle potty training in the house? *

Do you have further comments that might help us place the right Boxer with you?

How did you hear about us? *

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. *

Yes

Signature (please type full legal name) *

Today’s Date (mm/dd/yy) *

YYYY

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