ADOPTION APPLICATION
Which Boxer(s) are you interested in:
First Name:
Last Name:
Mailing Address:
City:
State:
ZIP Code:
Home Phone Number (with area code):
Cell Phone Number (with area code):
Occupation/Place of Employment:
Work Phone Number:
When is the best time to contact you?
E-mail Address(es):
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:
Have you ever owned a Boxer? Yes No
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 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
Do you have a color preference for a Boxer?
Describe how you till train the dog:
Have you applied with any other rescue? 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 what will happen to the adopted boxer?
Do you agree to provide at minimum an annual vet exam, shots and rabies, and to provide the vetting that this boxer needs? Yes No
Do you agree to keep your boxer on monthly heartworm prevention all year long? Yes No
Do you agree to restrain your boxer in an open vehicle? Yes No
Do you agree to return the Boxer to Boxer Rescue of Texarkana if you can no longer keep it? Yes No
Do you agree to a home visit from a Boxer Rescue of Texarkana representative before adoption? Yes No
What are your thoughts on crate training?
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 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. An Adoption 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 adopting a Boxer.
Validation Check: + 2 = 11
