Please Fill out the Entire Application All Fields Are Required

Minnesota Boxer Rescue

Adoption Application

Please fill out the entire application – All fields are required.

Personal information

Name (First & Last):Spouse’s name ( if applicable)

Email: Home Phone: Cell Phone:

Address: City: State: Zip:

Occupation Work Number: Work Schedules:

References

Please list two personal references (not related to you)

Name (first & last):Address:

City:State: Zip: Relation:

Contact number:

Name (first & last) Address:

City:State: Zip: Relation:

Contact number:

Family/Home information

I live in a : HOUSECONDOAPARTMENTMOBILE HOME

I OWNRENT(if renting please attach notarized statement from land lord authorizing you to have a dog (not restricted to size)

My Previous Address was : City: State: Zip:

I lived here for: Years / Months

Are you planning on moving in the next year?: yes no

Do you have a fenced yard?: yes no – if yes what is the height of your fence?

Please take a moment to describe your yard.

Do you have a kennel/run?: yes no

If no fence or kennel run how will exercise and toilet needs be met?

How many adults are in your home?:

How many children?: Ages of all children

Do you own any other dogs? yes no. (if yes please list below)

Pet #1

Breed Age Spay/Neutered yes no

Sex Male Female Current on vaccinations? yes no

Pet #2

Breed AgeSpay/Neutered yes no

Sex Male Female Current on vaccinations? yes no

Pet #3

Breed AgeSpay/Neutered yes no

Sex Male Female Current on vaccinations? yes no

Do you own a cat/s? : yes no How many?

Any other pets and/ or livestock yes no

About your Veterinarian

Veterinarian Information

Clinic name

Address City State Zip

Contact number

Additional Questions

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

What happened to them?

Why do you want a Boxer?

What are your plans for this dog?

Pet Guard Hunting Obedience Agility Other

Are you interested in any particular boxer we currently have in foster? (which one?)

Why are you interested in said boxer above?

If you are looking for future adoption what style of boxer are you looking for? (please check below)

Male Female Either

Fawn Brindle White Any Color

Age Puppy (11 months and under) 1-5 over 5

Would you adopt a dog with special needs? (deafness, daily meds, etc?) Yes No

Would you adopt a dog with a behavior problem (barking, chewing, etc) Yes No

Where would the dog spend most of each day INDOORSCRATEFENCED YARDBASEMENT/GARAGETETHERED/ CHAINKENNELOTHER Please note – Boxers can not withstand temperature extremes.

Where will the dog sleep? INDOORSFENCED YARDCRATEBASEMENT/GARAGEKENNEL OTHER

How many hours will the dog spend alone each day?

What is your definition of discipline?

Who will care for your dog during vacations?

Do you agree to the following?

Spay/Neuter with in 30 days (if applicable? Yes No

Keep current license and ID tags on dog at all times? Yes No

Provide timely health care for dog? Yes No

Annual Vaccines? Yes No

Restrain dog in open vehicle? Yes No

Return dog to the Minnesota Boxer Rescue if you can no longer keep or

care for the dog? Yes No

Allow Minnesota Boxer Rescue Agent to visit your home prior to adoption? Yes No

Allow Minnesota Boxer Rescue Agent to do home checks after Adoption? Yes No

Please initial each of the boxes below. If any of the boxes are left unmarked, your application will not be considered. If you are unable to check all of the boxes, you still need to think carefully as to whether a rescue boxer is the correct choice for your home.

I am at least 21 years of age.

I am indicating that this is a valid and legal substitution for my written signature on this legal document titled Minnesota Boxer Rescue Adoption Application.

I am stating that I am financially and physically able to care for this dog. I understand that proper food and veterinary care can be costly and I am able to meet these requirements.

I understand that if the information contained herein is found to be false, my application can be refused or said dog adopted shall be relinquished to the Minnesota Boxer Rescue without a refund of monies paid.

I understand that should I adopt from the Minnesota Boxer Rescue , the adoption fee goes toward the cost of caring for all the of the rescue dogs and that this fee is non-refundable.

Please print your name in the fields below as your signature and validation of information provided in this form.

Signature:

Date

Please return this completed form to our Adoption Coordinator Jodi @