First Name *

Last Name *

Your E-mail Address *

Your Occupation *

Your Employer *

Spouse's Name

Spouse's Occupation

Spouse's Employer

Spouse's E-mail Address

Street Address *

City, Province, PC *

Phone (daytime) *

Phone (evening) *

Reference (name) *

Reference (phone) *

Reference Name *

Reference Phone *

Relationship *

Years Acquainted *

Do you live in House in the country
Single family house
Townhouse
Condo
Apartment
Trailer
Other
*

Other

Do you own or rent? Own
Rent
*

If renting, are pets allowed? Yes
No

Is there a weight limit? If yes, what is the limit? Yes
No

What is the limit?

Landlord's name (if renting)

Landlord's phone (if renting)

Previous address (if less than two years at current address)

Do you have a fenced yard? Yes
No
*

Fence type

Fence height

What is the size of the yard? *

If not fenced, how do you propose to handle the dog's exercise and toilet duties?

Do you have a separate kennel run? Yes
No
*

Kennel run size

Do you have a doggie door? Yes
No
*

How many adults in the home? *

How many children? *

Children(s) ages?

Are any members of your household home during the day? Yes
No
*

Do you have other dogs? Yes
No
*

If yes, How many?

Are they spayed/neutered? Yes
No

Do you have cats? Yes
No
*

How many?

# of cats declawed

# of cats with claws

Are the cats spayed/neutered? Yes
No

Do you have any other animals/livestock? Yes
No
*

If you have other animals/livestock please list:

Who is your regular veterinarian *

Veterinarian's phone number *

Aproximate date of last visit ...

Were/are your animals current on vaccinations? Yes
No

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

What happened to them? (Lost, stolen, given away, etc.)

If any died, list age and cause

Have you owned boxers before? Yes
No
*

Why do you think a boxer is the right breed for you? *

What are your plans for the dog? (Pet, guard, hunting, obedience, etc.) *

Do you want Male
Female
*

Why *

Age preference? Yes
No
*

What is your age preference?

Why do you have an age preference?

Colour? Fawn
Brindle
White

Would you consider another sex, age, color? Sex
Age
Colour

Where will the dog spend most of the day? Loose indoors
Crate
Basement
Fenced yard
Loose outdoors
Tied up outdoors
Kennel run
Other
*

Other

How many hours a day will the dog be alone? *

Where will the dog spend most of each night? Loose indoors
Crate
Basement
Fenced yard
Loose outdoors
Tied up outdoors
Kennel run
Other
*

Other

When your family is away from home overnight or on vacation, what will you do with the dog? *

Do you agree to pay the spay/neuter fee if applicable? Yes
No
*

The adoption fee? Yes
No
*

Obey all leash laws? Yes
No
*

Provide regular health care for the dogs? Yes
No
*

Return the dog to Boxer Rescue if you can't keep it? Yes
No
*

Would you agree to a housecheck, prior to adoption? Yes
No
*

Have you or anyone in your immediate family ever been convicted of a charge of cruelty to animals? Yes
No
*

Are any such charges currently pending? Yes
No
*

Why do you feel you would like to acquire a dog at this time? *

How much do you think it would cost to feed the dog (per month)? *

How much do you think veterinary care would cost? (per month) *

What other expenses would you expect to pay? *

What is your definition of disciplining a dog? *

Why do you feel that a Rescue Boxer would be a right choice for you? *

Why do you feel that you would be the right choice for a Rescue Boxer? *

What do you think might be any special considerations to consider when adopting a Rescue Boxer? *

How did you hear about Boxer Rescue? *

How did you come to contact us about a Rescue Boxer? *