Adoption Application

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ONLINE ADOPTION APPLICATION

Boxer Rescue LA carefully screens each potential adopter to find the right home for each of our Boxers. Every Boxer has a different personality, traits and needs, so we carefully screen to make sure that we make a good match and this will be a permanent home for the Boxer.

ALL fields with * are REQUIRED or form won't process!
PLEASE ONLY SUBMIT FORM ONCE! Thank you ...

After submitting your application, you will be contacted by BRLA via phone or email.


* Your Name
* Street Address
* City/State/Zip
* E-Mail Address
* Phone #	* Work #	* Occupation

* Personal Reference
* Reference Phone #		* How Many Years Acquainted?

* Do you live in: House Apartment Condo Other
If Other, please explain:
* Do you own, rent or lease your home? Own Rent Lease
* How tall is your fence? 8 Foot 6 Foot 4 Foot No Fence
* Lowest point on the fence? 8 Foot 6 Foot 4 Foot No FenceIf Is your yard completely secure?:
* How many live in adults?	* Do you have children? Yes No
If children, please specify how many and their ages:
* Do you currently have any other dogs? Yes No
If yes: Breed[s] Sex Age[s]
* Are all your animals spayed or neutered? Yes No
If no, please explain why not:
* Do you have cats, other pets or livestock? Yes No
If yes, please list them here:

* Your Veterinarian

* Vet's Phone #

* How many dogs have you owned in the last 5 years?
* What happened to the other dog[s]? * Other dogs outside your home (family/friends) that will meet your new dog? * What issues would require you to return adopted dog[s]?
* Have you ever owned a Boxer? Yes No
* What do you like about Boxers?
* Why do you want to adopt a Boxer? Pet Guard Dog Both
* Would you prefer ... Fawn Brindle White No Preference * Would you prefer ... Male Female No Preference
* What age group best fits your family and lifestyle? 1-2 Years 2-5 Years 5+ Years No Preference
* Where will your Boxer spend most of the day?
If Other, please explain in detail:
* Where will your Boxer sleep at night?
Please explain exactly where new boxer will sleep in detail:
* How many hours will your Boxer be left alone each day?
* How much time will your Boxer spend in the house with the family each day?
* How will your Boxer get exercise?
* How will you discipline your Boxer? * When are you/your family ready to adopt a BRLA Boxer?
* How would you rate your leadership skills with dogs? Rate on scale of 1 to 10: 1 is all affection - 10 is alpha pack leader.
* Will you keep your Boxer's license current? Yes No
* Will you provide healthcare in a timely manner? Yes No
* Will you return your Boxer to BRLA if you can no longer care for it? Yes No
* Will you allow a Boxer Rescue LA representative to visit your home? Yes No
Additional Comments:
* How did you find out about BRLA?
If Other, please explain how you heard about us:

* Electronic Signature

Your electronic signature below serves as acknowledgement that this is a sincere inquiry, and that all information provided is true, correct and complete. On the Internet an Electronic Signature carries the same legal weight as if you were signing your name to a printed document. To complete this form, please provide your electronic signature below by typing your name in the box, then submit the form.

PLEASE ONLY SUBMIT FORM ONCE! Thank you ...

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