First Name:

Last Name:

Address:

Address 2 :

City:

State/Prov:

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Postal Code:

Telephone:

E-mail:

Occupation:

How did you hear about us:

Personal References (not related to you please):

Name:

Address:

Phone Number:

Relationship to applicant:

Years Acquainted:

Name:

Address:

Phone Number:

Relationship to applicant:

Years Acquainted:

Name:

Address:

Phone Number:

Relationship to applicant:

Years Acquainted:

Name, Address and Phone number of your current veterinarian. If you do not have any pets currently, but did, please provide previous veterinarian information:

Description of your Home:

What kind of home do you live in?
--Single Family Home Apartment Trailer Townhouse/Condo

Do you:
--Single Family Home Own Home Rent Live with Parents/Relatives

If you rent, please provide the name, address of the Landlord:

Phone Number of Landlord:

Are you planning on moving within the next year?

If yes, please explain:

Do you have a fenced in yard where you are presently living?

If yes or partial fencing, please provide approximate measurements, height and type of fencing:

Please list the names and ages of all person's living in the home:

If children are present in the home, have they ever been exposed to dogs before?

Is there anyone in your home with animal related allergies-If so please explain:

Additional Pets:

Do you own any other dogs presently?

If yes, are they spayed or neutered?

Other pets in home?

Pet#1

Pet#2

Pet#3

Pet#4

Pet#5

Pet#6

How many other dogs have you owned in the last 5 years?

What happened to your last dog?

Are all of your animals (dogs/cats) on heartworm preventative and flea and tick control?

If yes, what brand?

Boxer Knowledge

Have you ever owned a Boxer before?

Why do you want a Boxer:

What do you know and what have you learned about the Boxer dog:

Describe the type of dog you are looking for:

Would you consider adopting a dog with a treatable medical condition (heartworm)?

What age dog are you looking for:

Additional Pets:

Where will the dog spend most of the day?

If Indoors:

If Outdoors:

How many hours will the dog be alone each day:

List your hobbies and activities that you will be including your dog in (i.e., running, boating, biking, walking, hiking, etc):

Is someone home at all times or will the dog need to be alone for a portion of the day:

Where will dog sleep:

If indoors, where:

If outdoors, where:

Exercise and Discipline:

How would you exercise your dog:

Fenced area attached to home-please explain:

Walks on leash-please explain:

Other-please explain:

BIN's contract requires that all dogs 1 year old and under attend obedience training. Other dogs may also require mandatory training if specified in the adoption contract.

Are you willing to attend obedience classes with your new dog?

Would you like a referral for an Obedience Trainer?

What is your definition of disciplining a dog:

How would you handle a dog's destructive behavior? For example, dog gets into garbage, chews on shoe, etc:

Food and Other Expenses:

How much do you think it would cost to feed the dog a month:

What costs are involved in routine veterinary care for a dog:

What other expenses would you expect to pay:

Other:

What would you do if you could not keep the dog:

What kinds of behavior or for what reasons would you get rid of a dog:

Are you currently working with any other Boxer Rescues currently?

If yes, please provide the name, phone number, and e-mail address so that we may collaborate our efforts:

Do you agree to have dog neutered/spayed within 30 days of adoption if not already done?

Do you agree to keep current license and ID tags on dog at all times?

Do you agree to provide timely health care for dog?

Do you agree to return dog to Boxer Rescue if you can no longer keep or care for dog?

Further comments or additional information that you feel might help us find the right Boxer for your home:

Please let us know how you heard of our organization?

The adoption process generally takes 2 to 3 weeks to complete. Dogs that appear on our Web Site today, may, or may not be, available by the time the process is completed and you are approved to adopt. Please list the name(s) of any current dog(s) on our site that you may be particularly interested in: