Adoption / Fostering Application
Blue Ridge Boxer Rescue Adoption Application
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 *
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP *
Email Address *
Primary Phone *
Business Phone
Secondary Phone
Date of Birth (Must be 21 to apply) *
Date of Birth of Spouse / Significant Other
Any other adults in the household? *
Yes
No
If there are other adults in the household, please list them below
Do you own or rent? *
Own
Rent
If you rent, please list your landlord or property owner's contact information below:
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
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:
Child #1 Name:
Child #1 Age:
Child #2 Name:
Child #2 Age:
Child #3 Name:
Child #3 Age
Child #4 Name:
Child #4 Age:
Child #5 Name:
Child #5 Age:
Are your children used to being around pets?
Yes
No
If not, how will you teach your children the correct way to interact with your pet?
Do you have any dogs currently residing in your home? *
Yes
No
If you have dogs, please fill in the dog information for each:
Dog #1 Name
Dog #1 Age
Dog #1 Gender
Male
Female
Dog #1 Temperament
Dog #2 Name
Dog #2 Age
Dog #2 Gender
Male
Female
Dog #2 Temperament
Dog #3 Name
Dog #3 Age
Dog #3 Gender
Male
Female
Dog #3 Temperament
Dog #4 Name
Dog #4 Age
Dog #4 Gender
Male
Female
Dog #4 Temperament
Dog #5 Name
Dog #5 Age
Dog #5 Gender
Male
Female
Dog #5 Temperament
Are your current pets up to date on vaccines?
Yes
No
Are your current pets spayed and/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(s):
Do you have any pets, other than dogs, currently residing in your home? *
Yes
No
If you have other pets, please fill in the Pet information for each pet (cat, bird, etc.), age, and gender:
Pet #1
Pet #1 Age
Pet #1 Gender
Yes
No
Pet #2
Pet #2 Age
Pet #2 Gender
Male
Female
Pet #3
Pet #3 Age
Pet #3 Gender
Male
Female
Pet #4
Pet #4 Age
Pet #4 Gender
Male
Female
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
If so, please list fence type and height (i.e. chainlink 6ft)?
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? *
What is the maximum number of hours the dog will be left alone during the 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 the rescue(s) here:
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? *
Yes
No
If yes, please explain in detail)
Under what circumstances would you not be able to keep your new dog?: (Examples: new baby, divorce, marriage, new pet, illness, moving, etc) *
Please list 3 personal references whom you have known for at least 2 years (include phone # and email address). **PLEASE NOTE WE CAN NOT COMPLETE YOUR APPLICATION WITHOUT REFERENCES**
You can use only 1 family member as a reference; The other 2 references need to be non-related.
Reference #1 Name *
Reference #1 Phone
Reference #1 Email
Reference #2 Name *
Reference #2 Phone
Reference #2 Email
Reference #3 Name *
Reference #3 Phone
Reference #3 Email
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: