Lighthouse Boxer Rescue...lighting their way home
Friday, 31 Dec 2010
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Applicant References Home & Family Pets Preferences Agreement
PRIMARY APPLICANT
** First Name:      **  Last Name 
  E-mail address:
** Home Phone:  DaysEvenings
** Address:
**   City 
** State    Zip   County 
** Occupation:
** Employer:
CO-APPLICANT
** First Name:    Last Name: 
  E-mail address:
** Occupation:
** Employer:
** Required field
Applicant References Home & Family Pets Preferences Agreement
PERSONAL REFERENCE
Note: This must be a non-family member and cannot be someone living in your household.
** Name:  
** E-mail address:>
** Home Phone:  
** Yrs Acquainted
CURRENT VET (if applicable)
** Vet Name:
Clinic Name:
**

City, State:
** Phone:
PREVIOUS VET (if applicable)
Vet Name:
Clinic Name:
City, State:
Phone:
**Required field
Applicant References Home & Family Pets Preferences Agreement
HOME TYPE
**

Home type:

**

Own/rent: 

 Own   Rent   
**

RENTERS
Are pets allowed?   Yes No  
Pet limitations:
Landlord Name:
Landlord Phone:
** Previous Address:
FENCING/CONTAINMENT
** Fenced yard?    Yes No     
** Fence type:   
**   Fence height:
** Fenced area dimensions:
**  Kennel run? Yes No
** Describe kennel: 
** If no fence or kennel, how will exercise and toilet be handled?
HOUSEHOLD INFO
** # of adults: 
** Age(s) of adults:
** # of children:
**  Age(s) of children:
** Are there any family members who need special consideration for any reason? Yes No  
  • If yes, please explain:
**Required field
Applicant References Home & Family Pets Preferences Agreement
CURRENT PETS
Pet # Name Type Breed
(if dog)		 Sex Age Spay/ Neuter? Last vet visit date Last HW test date On HW prevent?
1
2
3
4
5
**

Comments: 
 
PET HISTORY
** How many dogs have you owned in the last 5 years?  
** What breed(s)? 
** What happened to your previous dog(s)?
** Have you ever owned a Boxer before?  Yes No
** If yes and you no longer have it, please explain why:
** Briefly, tell us why you want a Boxer:
**Required field
Applicant References Home & Family Pets Preferences Agreement
PREFERENCES (for multiple selections, hold the CTRL key and click on the values)
** What are your plans for this dog?
** Do you prefer:
** What color(s) do you prefer?
** What age group(s) do you prefer?
** Do you prefer the tail:
** Do you prefer the ears: 
** Would you accept a mix? Yes     No
PLANS FOR DOG
** Where will the dog spend most of each day?: 
 
  • If other, please explain: 
 
** Where will the dog sleep? 
 
  • If other, please explain: 
 
** How many hours will the dog be alone each day? 
** What is your opinion on formal obedience training classes?
 
** What is your opinion of crate training?
 
Further comments and/or information that you think might help us find the right Boxer for you:
 
**Required field
Applicant References Home & Family Pets Preferences Agreement
AGREEMENT
Do you agree to...
  • Spay/neuter within 30 days if the dog is not already altered? 
  • Keep current license and rescue tag on dog at all times?
  • Provide timely health care for the dog?
  • Restrain dog in open vehicle, i.e. pickup truck or convertible?
  • Allow Boxer Rescue agent to visit your home prior to or after adoption? 
  • Return dog immediately to Boxer Rescue if you can no longer keep or care for the dog?
Please initial the following items:
  • I agree by initialing this line that typing my name in is the same as signing my name to this legal document.
  • I give permission for the Boxer Rescue Agent to type my name to this document, causing it to be the same as my legal signature on this document.
  • I hereby testify that I am financially and physically able to care for this dog. I understand that proper food, vet care, bedding, toys, crate, etc can be costly and I am able to meet these requirements. I further testify that I am physically fit to provide all necessary activities with my dog.
  • I understand that if the information contained herein is in any way found to be false, my application can be refused or said adopted dog shall be relinquished to Boxer Rescue without a refund of the adoption fee.
  • I understand that the adoption fee is non-refundable.
Signature:  Date submitted: