Mail-In Adoption Application
Mail-In Adoption Application
If you should have any questions throughout your adoption
process please contact
Penny Teed, at pteed@rochester.rr.com
Please email the completed application to
boxerangelsdirectors@yahoo.com or mail or fax to:
PO Box 543
N. Bellmore, NY 11710
Phone: 212 971-2513
Fax:
860-739-3302 or
212 971-2592
Adoption
Application
BAR
places dogs throughout CT, NY, NJ and surrounding areas.
Answering these questions will help to us determine the best the best
possible dog for you and your lifestyle.
Please
return form as soon as possible to the address above.
Upon
our receiving your application you should hear from one of our volunteers within
24-48 hours. If you do not, email
the address above.
Please
allow 7 days for mailed applications.
Name: ______________________________ Home Phone:
_______________
Address: __________________________________
Cell Phone: ___________
City: _________________________
State: ________ Zip: __________
E-Mail Address: _________________________________
Best time and place to reach you: ______________________________________
Dominant Language Spoken: _______________________________
Occupation:___________________________
Employer: ____________________________ How long at current job: __________
Spouse/Significant Other’s Name: ________________________
Occupation: ___________________________________
Employer: _____________________________ How long at current job: ___________
Personal References (not related
to you please):
1) Name: ___________________________________
Address: _________________________________________ Tel # _______________
Relationship to applicant: ___________________ Years Acquainted: ___________
2) Name: ___________________________________
Address: _________________________________________ Tel # _______________
Relationship to applicant: ___________________ Years Acquainted: ___________
3) Name: ___________________________________
Address: _________________________________________ Tel # _______________
Relationship to applicant: ___________________
Years Acquainted: ___________
Name,
phone number and Address of your current veterinarian:
_______________________________________________________________________
_________________________________________________________________________
1. Do you live in: [ ] House... [ ] Apt... [ ] Trailer... [ ] Other __________________
2. Do you: [ ] Own... [ ] Rent
If you rent, please provide the name, address, and phone number of the Landlord ______________________________________________________________
____________________________________________________________________
How long at your current address? _____ years ______ months
Are
you planning on moving within the next year? _____ Yes ____ No
If
yes, please explain: ____________________________________________________
_____________________________________________________________________
4. Previous Address if less than 2
yrs at current residence:
______________________________________________________________
5. Do you have a fenced yard? [ ]
Yes... [ ]
No
Please provide Approximate measurements, height and type of fencing
________________________________________________________________________
________________________________________________________________________
6. Kennel run: [ ] Yes... [ ] No
Please provide approximate measurements _________________________
If no, how will exercise/toilet be handled? __________________________
7. Which best describes your home?
____ House in the country ____ House in the city
____ Townhouse ____ Apartment
____ Other - please explain ________________________________________________
_______________________________________________________________________
8. What are the requirements of dog ownership in your community? (i.e., licensing, rabies, leash laws, etc.) _______________________________________________________________________
_______________________________________________________________________
9. How many adults in your home? ____ Names and ages: _______________________________________________________________________
10. How many children in your home? _____ Ages: _______________________________________________________________________
11. Is there anyone in your home with animal related allergies? ______ If so, please explain _______________________________________________________________________
13.
Do you own any other dogs? [ ] Yes
[ ] No Are they spayed/neutered? [ ] Yes.[
] No
14. Are they up-to-date on vaccinations or have you had a titer test
performed on them within the last year?
15. Any other pets? [ ] Yes...
[ ] No
16. List names, breed and gender of each of your current pets (cats, dogs, etc.):
Pet #1 _____________________________________________________
Pet #2 _____________________________________________________
Pet #3 _____________________________________________________
Pet #4 _____________________________________________________
Pet #5 _____________________________________________________
17. How many dogs have you owned in
the last 5 years? ____________
18. What happened to your last dog? _____
Lost ____
Stolen _____ Given away
____ Died - list age and cause ______________________________________________
____ Other - please explain _______________________________________________
19. If your last dog was given away, please explain the circumstance and indicate the name and address of the person to whom the dog now belongs: _______________________________________________________________________
_______________________________________________________________________
20. Are all of your animals (dogs/cats) on heartworm preventative and flea and tick control?
___ Yes ___No What brand?
Boxer Knowledge:
21. Have you owned a Boxer before? [ ] Yes... [ ] No
22. Why do you want a Boxer? ______________________________________________________________________________________
__________________________________________________________
23. What do you know and what have you learned about the Boxer dog? _____________________________________________________________________________________
___________________________________________________________
24. Why would like to acquire a dog at this time?
____________________________________________________________________________________________
25. Describe the type of dog you are looking for by checking the appropriate boxes below
Do you want: [ ] Male [ ] Female [
] Doesn't matter
Do you want: [ ] Fawn [ ] Brindle [ ] White/Check [ ] Doesn't matter
Do you want: [ ] Natural Ears [ ] Cropped Ears [ ] Docked Tail [ ] Long Tail [ ] Doesn't matter
26. Would you consider adopting a dog with a treatable health condition, ie, heartworm? [ ] Yes [ ] No
27. Would you consider adopting a dog with a disability? For example, deaf, missing limb, heart condition, etc.
[ ] Yes [ ] No
28. Would you consider adopting a
boxer mix? [ ] Yes [ ] No
29. Do you want: [ ] Under 1 year [ ] 1-5 years [ ] Over 5 years [ ] Doesn't
matter
30. What are your plans for this dog? [ ]
Pet [ ] Guard [ ] Hunting [ ] Obed. [ ] Other
31. How far will you travel to
adopt a dog? ____________________________________
32. Where will dog spend most of each day? [ ] Indoors [ ] Outdoors
If indoors: [ ] crate [ ] Basement/Garage [ ] free run of house [ ] limited area of house [ ] Other (please explain)
____________________________________________________________________________________
____________________________________________________________
If outdoors: [ ] Fenced yard [ ] Tethered [ ] Kennel [ ] Outside shelter [ ] Other
Please provide specifics: _______________________________________________________________________
_______________________________________________________________________
33. How many hours will dog be alone each day? ________________________________________________________________________
34. List your hobbies and activities that you will be including your dog in (i.e. running, boating, biking, etc) ________________________________________________________________________________
________________________________________________________________
35. Is someone home at all times or will the dog need to be alone for a portion of the day?
___________________________________________________________________________________
_____________________________________________________________
36. Where will dog sleep?
Indoors [ ] or outdoors [ ]?
If indoors, where? [ ] Crate [ ]
Dog Bed [ ] Family Member’s Bed [ ] Basement/Garage
If outdoors, where?: [ ] Fenced yard [ ] Kennel [ ] Other
Please provide specifics: _____________________________________________________________________________________
___________________________________________________________
37. How would you exercise the dog? ________________________________________________________________________
Fenced area attached to home - please explain _____________________________
________________________________________________________________________
Walks on leash - please explain _______________________________________________________________________
Other - please explain _______________________________________________________________________________________
_________________________________________________________
38.
Are you
willing to attend obedience classes with your dog? [
] Yes [ ] No
Have you ever obedience trained
a dog before? [ ] Yes [ ] No
Would you like a referral? [ ] Yes [ ] No
Have you ever house trained a dog before? If yes please describe your method used.
__________________________________________________________________________________
______________________________________________________
39. What is your definition of disciplining a dog? __________________________________________________________________________________________
__________________________________________________________________________________________
____________________________________
40. How would you handle a dog’s destructive behavior? For example, dog gets into garbage, etc. __________________________________________________________________________________________
__________________________________________________________________________________________
____________________________________
42. How much do you think it would cost to feed the dog? ________________________________________________________________________
41. What brand of dog food would you use and how much? ________________________________________________________________________
43. How much do you think veterinary care would cost? ________________________________________________________________________
44. What costs are involved in routine veterinary care for a dog? _________________________________________________________________________
_______________________________________________________________________
45. What other expenses would you
expect to pay?
________________________________________________________________________
46. What would you do if you could not keep the dog? ___________________________________________________________________________________
___________________________________________________________________________________
__________________________________________________
47.What circumstances, in your mind, justify getting rid of a dog? ____________________________________________________________________________________
____________________________________________________________
48. Are you currently working with any other Boxer rescues? [ ] Yes [ ] No
If yes, please provide the name, phone number, and e-mail address so that we may collaborate our efforts ________________________________________________________________
49. Do you agree to the following?
Spay/Neuter within 30 days? [ ] Yes [
] No [ ] Not applicable
Keep current license and ID tags on dog at all times? [ ] Yes [ ] No
Provide timely health care for dog? [ ]
Yes [ ] No
Restrain dog in open vehicle? [ ] Yes
[ ] No
Return dog to Boxer Rescue if you can no longer keep or care for dog? [
] Yes [ ] No
Allow Boxer Rescue agent to visit your home prior to adoption? [ ] Yes [ ] No
50. Why do you feel that a Rescue Boxer would be a right choice for you?
_______________________________________________________________________________________
_______________________________________________________________________________________
__________________________________________
52. Further comments or additional information that you feel might help us find the right boxer for your home: _______________________________________________________________________________________
_______________________________________________________________________________________
__________________________________________
51. Please let us know how you heard of our organization:
________________________________________________________________________
53. Although it is not a requirement for adoption, would you will willing, post adoption, to volunteer to help other Boxers in need in any of the following ways? Please check those areas that you would consider helping with.
Transporting ____ Interviewing ____ Reference Checks ____
Fostering ____ Home Visits ____ Attending Expos ____
Fundraising ____ Other - Please Specify: _________________________________________
54. The adoption process generally takes 2 to
3 weeks to complete. Dogs that appear on our Web Site today, may, or
may not be, available by the time the process is completed and you are approved
to adopt. Please list the name(s) of any current dog(s) on our site that
you may be particularly interested in? ______________________
55. Would you be interested in fostering a dog with the possibility of
adopting it? __________________
Signature: _________________________________________ Date: ___/____/____
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