I am aware that BRBR dogs are placed only as indoor pets & agree to this. Yes No

I am aware that BEFORE I am approved to adopt, I will be visited in my home, by a BRBR Volunteer to determine that my home is a safe positive environment for a rescued dog. Yes No

Are you applying to adopt a rescued Boxer? Yes No

What dogs are you interested in and why?

Your Name:

Name of Spouse/Significant Other:

Street Address:

City:

State: NC SC VA

Zip Code:

Email Address:

Primary Phone: - -

Business Phone: - - Ext.

Secondary Phone: - -

DOB (Must be 21 to apply): January February March April May June July August September October November December / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1900 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986

Spouse/Significant Other DOB: January February March April May June July August September October November December / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1900 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985

Any other adults in the household?: Yes No
If yes, please list below

Do you own or rent?: Own Rent
If you rent, we are required to contact your landlord. Please list landlord's name and phone number:

How long have you lived at your current residence?:

Do you have any breed or weight restrictions if you rent or with homeowners insurance?: Yes No

What will happen to your pet if you move?:

Your Employer:

Your Spouse's Employer:

How long have you worked at your current job?: "> 0-3 months 3-6 months 6 months-1 year 1-3 years 3-6 years 7+ years

If less than 3 months; previous job and how long there:

Do you have children?: Yes No
If you have children, please list their names and ages:

Do you have any dogs currently residing in your home?: Yes No

Are your current pets spayed or neutered?: Yes No

If your pets are NOT spayed/neutered-please explain why?:

Are your current pets on Heartworm Prevention?: Yes No

If so, what brand?:

Name of past & present Veterinarian and PHONE number?:

Do you have any pets, other than dogs, currently residing in your home?: Yes No

In the past, have you owned any other pets?: Yes No

If they are not still with you, please explain in detail why?:

Do you have a yard?: Yes No

If so, is your yard fenced?: Yes No

What type/height (chain link/wooden)?:

If you do not have a fence, what do you plan to do for potty and exercise needs?:

Where will the dog be kept during the day when you are unable to be at home (free roam of house/crate/room/fenced area)?:

Where will the dog sleep at night?:

Who will feed-train-care for the dog?:

How many hours will the dog be left alone per day?:

Are you able to go home for lunch?: Yes No

Is anyone in your home allergic to dogs?: Yes No

Why do think you would be a good match for one of our rescued Boxers?:

What research have you done on the Boxer breed, such as health risks and personality traits?:

Do you have any obediance training knowledge?: Yes No

What behaviors do you consider unacceptable in a pet?:

Do all members of your family agree upon adoption? Yes No

Would you consider a special needs Boxer (on medication/blind/deaf)?: Yes No

Would you consider a silver Boxer (elderly)?: Yes No

Have you applied to any other rescues: Yes No   If Yes, please list:

Please list any gender/coat/ear/tail preference:

Have you EVER been charged with animal cruelty or animal neglect?: Yes No

In the past 5 years, have you had any pets that were lost, stolen or given away (if so please explain in detail):
Yes No

How were you referred to Blue Ridge Boxer Rescue?:

Have you owned a Boxer in the past?: Yes No

If you are approved to adopt; are you willing to assist in transportation to your home?: Yes No

Are you willing to allow a 30-60 day adjustment period for your new dog to adapt to your home, your family and any other pets?: Yes No

Many prospective adopters are surprised at the cost of food and medical expenses that are necessary to keep the animal in good health. During the first year you can expect to spend $ 300 - $ 500 for routine healthcare. Are you willing to make this financial commitment?: Yes No

Are you willing to make a commitment to this animal for the rest of his or her life?: Yes No

Do you understand that a dog will take time to adjust to its new surroundings and that certain behavioral issues might occur?: Yes No

Are you willing to work to correct these issues?: Yes No

Suggestions/Comments: