Adoption Application Page 6
ADOPTION Application
Today’s Date:
Full name of potential Adopter(s):
Your Home Address:
Your Mailing Address if different from above:
Your Home Phone #: Cell # if different:
Your Email Address:
Is there a particular boxer you are interest in? If so, which one:
We are applying for adoption and waiting for the right boxer for our family.
About THE BOXER’s Potential New Environment
YOUR Neighborhood
Please describe the neighborhood in which you live by placing an “X” in the space that best describes it:
Description of neighborhood: Suburban Urban/City Rural/Farm
Desciption of street on which ADOPTER lives: High Traffic Low Traffic Private Dirt Road Other
Would this be considered a safe neighborhood? Yes No
Is there a busy/dangerous intersection located near the home? Yes No
If yes, describe:
YOUR Home
Rent Own Type of dwelling: Apartment House Condo Mobile home other
If ADOPTER lives in an apartment, does the landlord approve of having large dog? Yes No
NOTE: If adopter rents, proof of landlord approval must be provided. Proof provided with application
Does the potential adopter plan to be moving in the next 12 months? Yes No
If yes, why and to where?
Where will this boxer(s) will be at night?
What will this boxer(s) have as bedding?
Where will this boxer(s) be when nobody is home? Inside house In crate In assigned room At “sitters”
Outside with shelter Other (specify):
yOUR Family
Please list the gender and age of all people living in your household:
NAME / AGE / NAME / AGE / NAME / AGE1 / 4 / 7
2 / 5 / 8
3 / 6 / 9
Is any family member opposed to the adoption? Yes No
If yes, please explain:
How many hours a day will the boxer be left alone during the week?
How long will the boxer be left alone on the weekend?
PLEASE NOTE: Re-homing is stressful on any new dog and some may have training accidents for the first few weeks. Common signs of stress: pacing, panting, drooling, loose stools, and appearing to have lost his way. How do you think you will respond to these behaviors?
yOUR Yard
Is the yard completely fenced? Yes No If yes what type of fencing?
Is the fence dog-proof? (No gaps along the bottom, no gaps between house and fence posts, no sagging areas, etc.)
Yes No If no, please explain:
Other Pets
Are there dogs or other animals that live adjacent to this property? Yes No
If yes, do you think they will be hostile toward a new family member? Yes No
Are there places a dog can leap off a deck and get injured? Yes No
Is there plenty of shade? Yes No
Are there other pets currently in residence? Yes No
If yes, please list all of them below:
NAME / AGE / TYPE OF ANIMAL / NEUTERED/SPAYED? / IS THIS PET FRIENDLY TOWARD NEW PETS?1 / Yes No
2 / Yes No
3 / Yes No
4 / Yes No
5 / Yes No
6 / Yes No
Who is your current veterinarian? Phone number of veterinarian:
Phone # of veterinarian who spayed/neutered your pets:
Please provide PROOF of neuter/spay for all dogs in your household.
Check here if you have other dogs and have requested your vet’s office to send them to
General Information
What are your plans to ensure this boxer(s) gets plenty of exercise?
ADOPTION Agreement (INITIAL EACH SECTON AFTER READING)
(INITIALS) ADOPTER named above hereby agrees, comprehends and assures that in receipt of BOXER to forever release, discharge and covenant to hold harmless Boxer Rescue of NWA (BR_NWA) or any person volunteering, representing or working for this BR-NWA or any other person, firm, or organization charged or chargeable with responsibility or liability, their heirs, administrators, executors, successors, and assigns from any and all claims, damages, costs, expenses, loss of services, actions and causes of action belonging to the said ADOPTER, arising out of any act or occurrence from the present time and particularity on account of the adoption of this boxer(s) named and described above. ADOPTER hereby declares that no representations about the nature of the adopted dog, nor any representations regarding the nature and extent of legal liability or of financial responsibility, have induced the adopter to sign this contract.
Collars and Tags
(INITIALS) Adopter agrees that this boxer(s) will not wear a pinch (cleat) collar or any similar article around the neck for the purpose of any basic training, any basic correcting, or for permanent use of identification. The pinch (cleat) collar is only to be used to correct a behavior problem which is an isolated incident and only under the guidance of a professional dog trainer, then not to be used for any other reason. The chain/choke collar (also referred to as training chain) will only be used to walk the dog on a leash if at all. A leash is required when the dog is taken out in a public area which enforces a leash law, any area which requires total control over the dog at all times, and any area which requires the dog to be leashed at all times when walked in a residential area. Boxer Rescue of NWA recommends a buckle collar or harness when collar/harness is needed; it is ADOPTER’s discretion as to whether the collar is to be worn at all times or only when needed for walks. This boxer(s) will not be let ‘off-lead’ outside of a fenced area until he/she performs a reliable recall. Obedience training is strongly recommended for all dogs.
Transition into ADOPTER’s Home
(INITIALS) Ensure that this boxer(s) understands your home IS his home before leaving the dog unattended in your yard. During transition period, confine dog to a room of adequate size (i.e. a laundry room, bedroom, or basement.) and protected from the elements of weather. ADOPTER is not to intentionally expose the dog to harmful objects, poisons, or other living creatures that may endanger the dog's life. The dog may be crated for no longer than eight (8) – ten (10) hours in a single stretch during a twenty-four (24) hour period of time. The crate must be large enough for the dog to stand up and turn around and must have the proper crate for the dog to lie comfortably on its side. An outside shelter or doghouse is not an acceptable residence but can be used only when needed in extreme heat, cold, or rain when the dog is let out into the yard for short periods of time and only when ADOPTER is at home or as excepted in this paragraph.
Training
(INITIALS) ADOPTER promises that under no circumstances will this boxer be used for animal research or experiments or trained to develop a dual personality, as defined: no protection, attack, schutzhund, or guard dog training is permitted. This boxer will not be encouraged to show any aggressive or agitated behavior. This boxer will be a family member only and only participate in good citizen, basic obedience, search and rescue, therapy dog training, or service dog training. This boxer will not be used for the purpose of being a deterrent due to size, appearance, or display and encouragement of territorial behavior (for example as a guard dog.)
Environment and Fencing
(INITIALS) This boxer shall reside indoors, in ADOPTER’s home, and live as a family member and companion only. This boxer may be left outside alone within secure and adequate fencing in moderate weather for short periods of time when weather permits. Please note that Boxers require an environment between 50–80 degrees.) Food, water and shelter should be available. If allowed outside, ADOPTER agrees that the definition of adequate fencing is:
1) a fence that encloses a yard or a large pen, larger than the outdoor kennel.
2) An adequate fence is one that prevents the dog within to go out of the area by jumping, digging, or exiting through
gates not properly secured.
3) The fence will prevent any other animal from entering the property on which BOXER lives and
4) is secure enough to prevent intruders or small children from easily gaining entry.
An adequate fence does not include a split rail fence. Invisible or underground fencing is not acceptable. A shock or electric collar is not acceptable. A kennel environment is not acceptable for housing, safety, or the emotional well being of the dog. If the dog should be able to jump over, or dig under the fence it is no longer an adequate fence and must be repaired by raising it to six (6) feet or sealing any and all weak spots immediately. Boxer Rescue of NWA, not by the adopter, will make the decision on whether a home is adequately fenced. While the fence is not serving the purpose ADOPTER shall not leave the dog unattended in the yard at any time.
Health Maintenance
(INITIALS) This boxer shall be fed a wholesome and complete diet of dog food and provided fresh water at all times. Rescued puppies must begin heartworm preventative at four (4) months of age and shall receive the rabies vaccine as required by law and remain on heartworm preventative year round with yearly testing throughout the entire lifespan of the dog. Rescuer reserves the right to verify with the ADOPTER’S veterinarian that the heartworm preventative has been purchased and that the dog has a yearly blood test for this purpose. The dog shall also have yearly booster shots of DHLPP and Bortadella. If not vetted by Boxer Rescue of NWA, an adopted adult dog must be seen by a veterinarian within seven (7) days of receipt of the adoption contract to commence a heartworm preventative program and to get a fecal test done to ensure dog is free of parasites. (BOXER HAS BEEN TESTED FOR PARASITES AND HEARTWORMS AND HAS BEEN ON THE PREVENTATIVE TREATEMENT; ALL VACCINES ARE UP TO DATE.) The adult dog shall also have lifetime veterinary care to include yearly vaccinations, emergency treatment as needed, prevention of parasites, fleas, ticks and heartworms and be provided adequate flea and tick control when required. Renewal of rabies vaccine is required by law and therefore by the terms of this agreement.
Transportation
(INITIALS) This boxer will not ride in the back of a pickup truck under any circumstances including those such as in a cage/kennel, or tied. The dog shall not remain in any vehicle in extreme heat, with windows down, or unattended.
Important Notice Regarding Temperament
(INITIALS) Boxer Rescue of NWA makes no explicit or implicit guarantees in reference to the health and/or temperament of this boxer. All boxers are adopted "as is" and ADOPTER assumes all responsibility for treatment of any and all existing conditions or any other conditions of physical or temperament changes that may occur. Boxer Rescue of NWA will provide each dog with basic vaccines and heartworm test before adoption (if the age and current health of the dog permits.)
While Boxer Rescue of NWA makes every effort to place only healthy animals unless otherwise noted, BR-NWA cannot guarantee the health of any animal and shall not be held responsible for any health issues or associated medical expenses which may be incurred, hereby expressly excluding any implied or express warranties of merchantability or fitness for any particular purpose, including, without limitation, any warranties regarding health, temperament or whether the animal is housebroken.
If the boxer has recently finished heartworm treatment, it will not test negative until up to 6 months to 1 year and will need to be kept on heartworm preventative such as liquid Ivermectin or Heartguard (not Sentinel). There is a very slim possibility that the boxer may not test negative even after 1 year. If such case, ADOPTER IS required to ask his/her vet about the best course of treatment. It is unlikely, but possible, that the boxer will need additional heartworm treatment. In addition, there are certain stages of the heartworm larvae that are not detected by any test. Thus, even though the heartworm test is negative, a positive test can occur at a later stage of development.
Remedy for Non-compliance
(INITIALS) Should it at any time be brought to the attention of this rescue that the proper and humane care as specified in the above adoption provisions is not being afforded above described dog, said animal may be taken through a claim and delivery proceeding. ADOPTER agrees that if there is any breach or default of the terms of this contract, and the dog must be redeemed through a claim and delivery service, ADOPTER will be held liable for all court costs and fees for both ADOPTER and BR-NWA's attorney. Should it become necessary for BR-NWA to take action to recover an adopted BOXER or otherwise enforce the provisions of the adoption contract agreement, the undersigned ADOPTER(s) will be responsible for all court costs and all attorney fees representing either the adopter or rescuer.
Cosmetic Surgery
(INITIALS) Unless directed by a licensed veterinarian for reasons related to the health and welfare of the dog, cosmetic surgery will not be performed under any circumstances, including but not limited to tail docking or ear cropping.