Name
*
First Name
Last Name
Date of Birth
*
MM
DD
YYYY
Current Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email
*
Phone Number
*
(###)
###
####
Are you interested in fostering or adopting?
*
Fostering
Adopting
What is your occupation?
*
Spouse Name
First Name
Last Name
How long have you lived at your current address?
*
Personal Reference Name
*
Must not be a family member.
First Name
Last Name
Reference's Phone Number
*
(###)
###
####
Reference's Email
*
How do you know your reference?
*
What type of community do you live in?
*
Country Home
Urban
Suburban
Condo
Apartment
Other
Do you own your home?
*
Yes
No
Are pets allowed in your home?
*
Yes
No
Landlord's Name
(If applicable)
First Name
Last Name
Landlord's Phone Number
(If applicable)
(###)
###
####
Fence Type
If no fence, how will you handle exercise and toilet needs?
How many adults are in your home?
*
How many children are in your home?
*
Are any members of your household home during the day?
*
Yes
No
Do you have other dogs?
*
Yes
No
If yes, how many? Please list name/breed/age
Are they all spayed/neutered?
Yes
No
If not, please tell us which ones are not and why.
Do you have any other animals/livestock?
*
Yes
No
If yes, please list them.
Who is your regular/most recent veterinarian?
First Name
Last Name
Vet Clinic's Name
*
Veterinarian's Phone Number
(###)
###
####
Approximate date of last vet visit
MM
DD
YYYY
Is/Are your current dog/s up to date with heartworm testing and prevention?
*
Yes
No
N/A
Are your animals current on vaccines?
*
Yes
No
N/A
How many dogs have you owned in the last five years?
*
What happened to them?
(i.e. boxer - still have, boxer - died, dachsund - lost or stolen)
If any died, list their ages and causes.
Have you owned boxers before?
*
Yes
No
Why do you think a boxer is the right breed for you?
*
Are you willing to consider a boxer mix?
*
Yes
No
If adopting, which of our dogs, if any, are of particular interest to you?
*
Where will the dog spend most of the day?
*
How many hours a day will the dog usually be alone?
*
Where will the dog spend most of each night?
*
Adoption fees are $350. Do you understand your fee will be due at the time of adoption?
*
Yes
No
Do you agree obey all leash laws?
*
Yes
No
Do you agree to provide regular health care for the dog(s)?
*
Yes
No
Do you agree to return the dog to MTBR if you can't keep it?
*
Yes
No
Would you agree to a house check prior to adoption?
*
Yes
No
Have you or anyone in your immediate family been convicted of a charge of animal cruelty, or are charges pending?
*
Yes
No
What is your manner of disciplining a dog?
*
How did you hear about Middle Tennessee Boxer Rescue?
*
If your answer was Friend, Neighbor or Family Member, please let us know who:
MTBR is committed to finding successful homes for the life of our dogs. Do you intend to commit for the life of the dog?
*
Yes
No
By submitting this form, I swear that all information contained is true and complete.
*
Yes
No