Please enter your Town & State After the text, Like You
See Below.
(Ex. Adoption Application - Leonia, NJ)
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Full Name:
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Email Address:
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Home Phone:
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Work Phone:
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Cell Phone:
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Address (City, State & Zip Required):
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County:
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Occupation:
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How long at this job?
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Do you work?
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From Home
Office
On The Road
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Spouse/Significant Other Name:
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Spouse/Significant Other Occupation:
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How long at this job?
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Does he/she work?
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From Home
Office
On The Road
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Spouse/Significant Other Phone:
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How many adults in home?
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Names & Ages Of Adults:
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How many children in the home?
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Names & Ages Of Children:
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Are there any special needs/disabilities/allergies?
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Are you working with any other rescue groups?
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Yes
No
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If so, who?
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What best describes your home?
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Do you own or rent?
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How long at this address (Year/Months):
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If you rent, provide name & number of landlord:
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Do you plan to move within the next year?
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Yes
No
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Does your home have a yard?
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Yes
No
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Is it securely fenced?
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Yes
No
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Fence height & Type:
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If no fence, how do you plan to exercise dog?
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Do you have any other dogs?
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Yes
No
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Are they spayed/neutered?
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Yes
No
Not Old Enough Yet
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Are vaccinations up to date?
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Yes
No
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Do you have any cats?
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Yes
No
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Other Pets or Livestock?
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Yes
No
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List name, type, breed, sex and age of each of your current pets:
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Are all dogs/cats on heartworm preventative?
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Yes
No
N/A
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How many dogs have you owned in the past five years?
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What happened to your last dog?
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If dog was given away, explain to who and why:
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Have you owned a boxer before?
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Yes
No
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Why is the boxer the right breed for you?
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List activities in which you plan to include your dog:
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Age preferred/oldest you would consider adopting:
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Sex of dog you would prefer:
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Color Preference:
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Would you crop ears/dock tail if it was not done already?
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Yes
No
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Would you take a mix?
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Yes
No
Maybe
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Are you interested in a particular dog on the site?
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Yes
No
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If yes, which one(s)?
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What are your particular preferences for a dog if any, such as: doesn’t get on furniture, must like cats, good with children, etc:
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Would you consider adopting a special needs dog (i.e. a deaf dog or a dog requiring daily medication)?
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Yes
No
Maybe
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Who will be the dogs primary care giver?
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How many hours (on average) will the dog be left alone?
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What will you do if your dog is destructive while alone?
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List unacceptable behavior problems:
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How would you discipline your dog?
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Where will the dog sleep? Check All That Apply
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Crate
Family Member's Bed
Garage
Fenced Yard
Kennel
Dog Bed
Basement
Porch
Outside Shelter
Dog House
Other
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Would you attend obedience classes with your dog?
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Yes
No
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What kind of food do you plan to feed your dog?
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What would you estimate to be a realistic cost to properly care for your dog for a year?
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Provide Veterinarian's name and telephone number for each of your current and prior pets:
IF YOU DO NOT PROVIDE A PHONE NUMBER FOR YOUR VET, YOUR
APPLICATION WILL NOT BE PROCESSED!
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What would justify getting rid of a dog?
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Please provide the names & numbers or three (3) personal references, including their relationship to you:
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Comments:
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By checking this box, I have indicated that this is a valid and legal substitution for my written signature on this legal document entitled "Adoption Application."
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Agree
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By Checking this box, I state that I am financially and
physically able to care for this dog. I understand that proper
veterinary care, training and food can be costly, and I am able
to meet these requirements.
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Agree
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By checking this box I certify my understand that the $350.00 adoption fee will be used for the care of all the dogs within New Jersey Boxer Rescue, Inc., and this fee is non-refundable.
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Agree
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By checking this box I certify that all information contained herein is true. If any of the information provided in this document is found to be false, my application can be refused or said dog adopted shall be relinquished to New Jersey Boxer Rescue, Inc. without a refund of monies paid.
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Agree
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By checking this box I certify that I am 21 years old (see NJBR adoption policy, you must be 21 years old to adopt)
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Agree
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