Your email address: (e.g.: you@aol.com)

Your home phone number (with area code):

Your work phone number (with area code):

Address:
City:	State: Zip Code:

Your mailing address: (if different)

Your employer:

Your occupation:

Please list names and occupations of other adults in the household:

Name of a personal reference:
Phone number of personal reference:
Years acquainted:

Do you have pets currently? If so please list breed, sex and age of each:

Are all of your current pets spayed or neutered?:
Yes, all pets currently are spayed or neutered.
No, all pets are not currently spayed or neutered.

If your current pets are not spayed or neutered, why?

In the past 5 years have you had any other pets?:
Yes, I have had other pets in the past 5 years.
No, I have not had other pets in the past 5 years.

In the past 5 years have you had any other pets that are no longer with you? Why are they no longer with you?:

Why do you want to adopt a boxer?:

What research have you done on the boxer breed if you haven't owned a boxer before?:

Describe the dog you are looking for (age, sex, color, etc):

Would you consider a special needs boxer or a senior boxer?:
Yes, I would consider a special needs or a senior boxer.
No, I would not consider a special needs or a senior boxer.

What are your plans for this dog?:
This dog will be a pet.
For guarding my home or office.
For hunting.
I would like a dog for breeding.
Other. Please describe:

Have you ever had to give up a dog?:
Yes, I have given up a dog.
No, I have never given up a dog.

If you have given up a dog before, why?

Who will feed, exercise and train the dog?:

How do you plan to train the dog?:

Are you willing to attend an obedience class with the adopted dog?:
Yes.
No.

Where will the dog sleep at night?:

How many hours will the dog be alone each day?:

Where will the dog be kept during the day?:

Who will take care of the dog in your absence (vacations, emergencies)?:

Do you currently have a veterinarian?
Yes, I do have a veterinarian.
No, I do not have a veterinarian.

If you do have a veterinarian please list their name, city and phone with area code:

If you do not have a veterinarian, how do you plan to find one?:

Describe your current accomodations:
I live in an apartment.
I live in a condominium.
I live in a single family home.
I live on acreage.
I live in a mobile home.
Other. Please describe:

How long have you lived at this address?:

If less than a year where did you live previously?:

Describe your yard:

Is your yard fenced?:
My yard is fenced.
My yard is not fenced.
I have a safe enclosure or kennel.
If your yard is fenced, how tall is it?:

If you do not have a fence, how will exercise/toilet be handled?

Do you own or rent?
I own my home.
I rent my home.

If you rent, do you have permission to have a dog?:
Yes, I do have permission to have a dog.
No, I do not have permission to have a dog.

Landlord's name:

Landlord's phone:

May we contact your landlord to verify that you may have a dog on your property?:
Yes, you may contact my landlord to verify my permission to have a dog.
No, you may not contact my landlord to verify my permission to have a dog.

May we visit your home before and after you adopt a dog?:
Yes, you can visit my home before and after adoption.
No, you cannot visit my home before and after adoption.

Is anyone in your home allergic to animals?:
Yes, someone in the household is allergic to animals.
No, no one in the household is allergic to animals.

How long do you plan to keep this dog?:

How much money would you consider to be a major medical expense?:

Is your entire household supportive of this adoption?:
Yes, the entire household supports this adoption.
No, the entire household does not support this adoption.

If the entire household does not support this adoption please explain why:

How did you find out about us?:
I found you on a web search engine.
I found you on a website link.
I found you in a newspaper ad.
I found you in a magazine ad.
I found you by word of mouth.
Other. Please describe:

Any additional comments or questions: