Online Adoption Application
* Required
Email address
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Your email
Which Boxer(s) are you interested in
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Your answer
Have you read the description of the Boxer(s) you are interested in?
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Yes
No
Have you read our Requirements and meet them?
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Yes
No
Applicant Name
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Your answer
Physical Address/Mailing Address if different
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Your answer
City/State/Zip Code
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Your answer
Cell Phone Number (with area code)
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Your answer
Home Phone Number (with area code)
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Your answer
Occupation/Place of Employment
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Your answer
Work Phone Number
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Your answer
When is the best time/days to contact you?
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Your answer
Spouse/Partner's Name
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Your answer
Spouse/Partner's Cell Phone
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Your answer
Spouse/Partner's Place of Employment
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Your answer
Spouse/Partner's Work Phone Number
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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/Best time to contact
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Your answer
Name/Phone Number of Personal Reference 2/Best time to contact
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Your answer
Name of Your Veterinarian
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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)??
Your answer
Veterinarian’s Address/City/State/ZIP code
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Your answer
Veterinarian’s Phone Number (with area code)
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Your answer
How many people reside in your home?
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1
2
3
4
5
Other:
Do you have children in your home?
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Yes
No
If ‘Yes’ to the question above, list number of children and their ages.
Your answer
Who in the home will care for the dog?
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Your answer
Housing
Where do you live?
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House
Apartment
Condo
Mobile Home
Military Housing
Other:
Do you own or rent your home?
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Own
Rent
If you Rent, have you received the approval of your Landlord to have an animal?
Yes
No
Clear selection
Landlord’s Name and Phone Number (with area code)
Your answer
Is your yard fenced?
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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
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Your answer
How much time will the dog spend alone during the day?
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Your answer
Where will the dog be kept when you are not home?
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Your answer
Where will the dog be kept when you are home?
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Your answer
Where will the dog sleep?
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Your answer
Pet Section
Do you have pets?
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Yes
No
Pet #1 Name/Breed/Age
Your answer
Is pet #1 spayed or neutered?
Yes
No
Clear selection
Is pet #1 shots/rabies up to date?
Yes
No
Clear selection
Is pet #1 given heartworm preventative?
Yes
No
Clear selection
What heartworm prevention?
Your answer
Pet #2 Name/Breed/Age
Your answer
Is pet #2 spayed or neutered?
Yes
No
Clear selection
Is pet #2 shots/rabies up to date?
Yes
No
Clear selection
Is pet #2 given heartworm preventative?
Yes
No
Clear selection
What heartworm prevention?
Your answer
Pet #3 Name/Breed/Age
Your answer
Is pet #3 spayed or neutered?
Yes
No
Clear selection
Is pet #3 shots/rabies up to date?
Yes
No
Clear selection
Is pet #3 given heartworm preventative?
Yes
No
Clear selection
What heartworm prevention?
Your answer
Pet #4 Name/Breed/Age
Your answer
Is pet #4 shots/rabies up to date?
Yes
No
Clear selection
Is pet #4 shots/rabies up to date?
Yes
No
Clear selection
Is pet #4 given heartworm preventative?
Yes
No
Clear selection
What heartworm prevention?
Your answer
Pet #5 Name/Breed/Age
Your answer
Is pet #5 spayed or neutered?
Yes
No
Clear selection
Is pet #5 shots/rabies up to date?
Yes
No
Clear selection
Is pet #5 given heartworm preventative?
Yes
No
Clear selection
What heartworm prevention?
Your answer
**If you have more then 5 pets list them here including name/breed/age and vetting asked in pets above
Your answer
Do you have other pets or livestock? Please explain.
Your answer
Have you given up a pet?
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Yes
No
If yes, please explain the circumstances
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Your answer
What happened to past pets?
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Your answer
Have you owned a Boxer?
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Yes
No
What is your experience with Boxers?
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Your answer
Why are you interested in adopting a boxer at this time?
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Your answer
What are you looking for in a Boxer? Select all that apply:
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Female
Male
Baby
Young
Adult
Senior
Companion
Companion for another pet
Protective
Other:
Required
Do you have a color preference for a Boxer?
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Your answer
Describe how you will train the Boxer.
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Your answer
Have you applied to other rescues to adopt?
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Yes
No
If applied to other rescues, please name the rescue(s).
Your answer
Do you know there is an adoption fee?
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Yes
No
Do you agree to spay/neuter if the boxer is too young or has a medical condition and can’t have it before adoption?
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Yes
No
Are you planning to stay at your current address?
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Yes
No
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?
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Yes
No
Do you agree to keep your boxer on heartworm prevention all year long for the rest of the Boxer's life?
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Yes
No
Do you agree to not transport your boxer in an open vehicle?
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Yes
No
Do you agree to return the Boxer to Boxer Rescue of Texarkana if you can no longer keep it?
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Yes
No
Do you agree to a home visit from a Boxer Rescue of Texarkana representative before adoption?
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Yes
No
Do you crate your dogs when not home? What are you thoughts on crate training?
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Your answer
Do you have doggie door?
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Yes
No
When do you use the doggie door?
Your answer
What are your thoughts on obedience training?
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Your answer
How would you handle potty training in the house?
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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?
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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.
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Yes
No
Signature (please type full legal name)
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Your answer
Today’s Date (mm/dd/yy)
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MM
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DD
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YYYY
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