Online Adoption Application
* Required
Email address
*
Your email
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
Yes
No
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?
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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?
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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?
*
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?
*
Own
Rent
If you Rent, have you received the approval of your Landlord to have an animal?
Yes
No
Landlord’s Name and Phone Number (with area code)
Your answer
Is your yard fenced?
*
Front Yard Only
Back Yard Only
Both Yards Fenced
Unfenced Yard(s)
No Yard
Other:
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?
*
Yes
No
Pet #1 Name/Breed/Age
Your answer
Is pet #1 spayed or neutered?
Yes
No
Is pet #1 shots/rabies up to date?
Yes
No
Is pet #1 given monthly heartworm preventative?
Yes
No
What heartworm prevention?
Your answer
Pet #2 Name/Breed/Age
Your answer
Is pet #2 spayed or neutered?
Yes
No
Is pet #2 shots/rabies up to date?
Yes
No
Is pet #2 given monthly heartworm preventative?
Yes
No
What heartworm prevention?
Your answer
Pet #3 Name/Breed/Age
Your answer
Is pet #3 spayed or neutered?
Yes
No
Is pet #3 shots/rabies up to date?
Yes
No
Is pet #3 given monthly heartworm preventative?
Yes
No
What heartworm prevention?
Your answer
Pet #4 Name/Breed/Age
Your answer
Is pet #4 shots/rabies up to date?
Yes
No
Is pet #4 shots/rabies up to date?
Yes
No
Is pet #4 given monthly heartworm preventative?
Yes
No
What heartworm prevention?
Your answer
Pet #5 Name/Breed/Age
Your answer
Is pet #5 spayed or neutered?
Yes
No
Is pet #5 shots/rabies up to date?
Yes
No
Is pet #5 given monthly heartworm preventative?
Yes
No
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?
*
Yes
No
If yes, please explain the circumstances
*
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?
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:
*
Female
Male
Baby
Young
Adult
Senior
Companion
Companion for another pet
Protective
Other:
Required
Do you have a color preference for a Boxer?
*
Your answer
Describe how you will train the Boxer
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Your answer
Have you applied to other rescues to adopt?
*
If applied to other rescues please name.
Yes
No
Do you know there is an adoption fee?
*
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?
*
Yes
No
Are you planning to stay at your current address?
*
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?
*
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 restrain 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
What are your thoughts on crate training?
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Your answer
What are your thoughts on obedience training?
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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.
*
Yes
No
Signature (please type full legal name)
*
Your answer
Today’s Date (mm/dd/yy)
*
MM
/
DD
/
YYYY
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