Last Name:
Mailing Address:
City:
State:
ZIP Code:
Home or Cell Phone Number (with area code):
Occupation/Place of Employment:
Work Phone Number:
When is the best time to contact you?
E-mail Address:
Spouse/Partner’s Name:
Spouse/Partner’s Cell Phone:
Spouse/Partner Place of Employment:
Spouse/Partner Work Phone Number:
Spouse/Partner E-mail Address:
You will need to list two (2) personal references below. You may use ONLY one (1) family member as a reference.
Name of Personal Reference 1:
Phone Number of Personal Reference 1:
Name of Personal Reference 2:
Phone Number of Personal Reference 2:
Name of Your Veterinarian:
Veterinarian’s Mailing Address:
Veterinarian’s City:
Veterinarian’s State:
Veterinarian’s ZIP Code:
Veterinarian’s Phone Number (with area code):
How many people reside in your home?
Do you have children in your home? Yes No
If ‘Yes’ to the question above, list number of children and their ages.
Who in the home will care for the dog?
Do you have live in a (select one): House Apartment Condo Mobile Home Military Housing
Do you Rent or Own your home? Rent Own
If you Rent, have you received the approval of your Landlord to have an animal? Yes No
If you Rent, we will need your Landlord’s name and phone number:
Landlord’s Name:
Landlord’s Number (with area code):
Is your yard fenced? (select one): Front Yard Only Back Yard Only Both Yards Fenced Unfenced Yard(s) No Yard
Describe fence type, height(s),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?
Do you have other pets? Yes No
If you have other pets, please answer the questions below:
Pet #1:
Pet’s Name:
Type of Pet:
Age of Pet:
Is pet spayed or neutered?
Is pet’s shots/rabies up to date?
Is pet given monthly heartworm preventative?
Pet #2:
Pet #3:
Pet #4:
Pet #5:
List other pets and related information here:
What happened to past pets?
Have you given up a pet? Yes No
If you have ever given up a pet, please explain the circumstances:
Why are you interested in fostering a boxer at this time?
Describe how you will train the dog:
Do you agree to a home visit from a Boxer Rescue of Texarkana representative before fostering? Yes No
What are your thoughts on crate training?
What are your thoughts on obedience training?
What are your thoughts on a foster having a potty accident in your home?
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 No
Signature (please type full legal name):
Today’s Date (mm/dd/yy):
Please click the ‘Submit’ button below to submit your application to Boxer Rescue of Texarkana. We are a small local rescue and we also have full time jobs. A Foster Coordinator will be in contact with you as soon as possible to help you find the right Boxer for your family. Thank you for your interest in fostering a Boxer.
Validation Check: 9 + 3 =
