BoxAR - Arkansas Boxer Rescue

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NOTE: Angelfire is having difficulties with forms. If you receive an error message after submitting this form, please use your back button to return to this page. You may print a hard copy of this application, complete it, and then mail it via USPS to the coordinator. You may also contact the coordinator to get a back-up text version of the application. We apologize for any inconvenience.

BoxAR Rescue
Adoption Application

Personal Information:
	Your Name:
	Your Phone Number:
	Your E-mail Address:
	Your Occupation:
	Spouse's Name:
	Spouse's Occupation:
	Spouse's E-mail Address:
	Street Address:
	City, State, Zip:

References:
	Personal Reference (name):
	Personal Reference (phone):

	Reference who has known your animals and you as a pet owner:
	Name:
	Phone:
	Relationship:
	Years Acquainted:


Housing Information:
	Do you live in:
		House in the country
		Single family house
		Townhouse
		Condo
		Apartment
		Trailer
		Other (describe below):

	Do you own or rent?	Own Rent
	If renting, are pets allowed?	Yes No
	Is there a pet weight limit? If yes, what is the limit?	Yes No 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

Family Situation:
	How many adults in the home?
	How many children?
	Child(ren)'s age(s)?
	Are any members of your household home during the day?	Yes No

Veterinarian Info:
	Who is your regular veterinarian?
	Veterinarian's phone number:
	Approximate date of last visit:

Pet History:
	Do you have other dogs?	Yes No
	How many?
	Are they spayed/neutered?	Yes No
	Are your animals current on vaccinations?	Yes No
	Are your dogs on monthly heartworm preventative?	Yes No
	If yes, what brand?
	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?


	Do you have cats?	Yes No
	How many?
	Are they declawed?	# declawed # with claws
	Are they spayed/neutered?	Yes No

	Do you have any other animals or livestock?	Yes No
	Please list:

Rescue Dog Plans and Expectations:
	What are your plans for this dog? (Pet, Guard, Hunting, Obedience, etc.)

	Where will the dog spend most of the day?	Loose indoors Crate Basement Fenced yard Loose outdoors Tied up outdoors Kennel run Other (explain below) :

	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 (explain below):

	When your family is away from home overnight or on vacation, what will you do with the dog?
	Why would you 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 (annually)?
	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 the 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 special considerations when adopting a rescue Boxer?

Dog Preferences:
	Do you want:	Male Female
	Why?
	Age preference?	Yes No Age Preference Range
	Why do you have an age preference?
	Color?	Fawn Brindle White No Preference
	Would you consider another sex, age, color?	Sex Age Color
	Would you consider a boxer-mix?	Yes No

Consent / Acknowledgment:
	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 dog?	Yes No
	Restrain the dog in an open vehicle?	Yes No
	Keep your new rescue Boxer as an indoor dog?	Yes No
	Return the dog to BoxAR Rescue if you can't keep it?	Yes No
	Would you agree to a home check, 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
	How did you hear about BoxAR Rescue?
	How did you come to contact us about a rescue Boxer?
		NOTE: By submitting this BoxAR Rescue Adoption Application, you are agreeing that it and all accompanying documentation is true and factual. You also acknowledge that you are at least 21 years old. BoxAR Rescue reserves the right to reject any application for any reason at any time.

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