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Missouri
Valley Boxer Club - Boxer Rescue
Prospective Owner Information
(Please PRINT)
DATE:
________________________
NAME:
___________________________________________________________________________
ADDRESS:
_______________________________________________________________________
PHONE: HOME _______________________________ WORK
______________________________
E-MAIL ADDRESS:
_________________________________________________________________
DOG PREFERENCES:
AGE (Circle one): Puppy 6-12mo 1-2yr 3-4yr 5-7yr Senior
No Preference
SEX (Circle one): Male Female
No Preference
COLOR (Circle one): Fawn Brindle Reverse Brindle White
No Preference
FENCING (Circle one): None Chainlink (ht:______) Privacy Invisible Kennel/Run ___X___ft
If you currently do not have fencing, how will exercise/toilet be handled?____________________________
____________________________________________________________________________________
YOUR HOUSING ACCOMMODATIONS:
Describe your current accommodations. Please circle one:
Apartment Condominium Single family home
Acreage Mobile home
Other (describe)
___________________________________________________________________
How long have you lived at this address? ________________________________
Describe your yard: _________________________________________________________________
If you rent, do you have permission to have a dog? Yes
____ No ____
Landlord's name: _______________________________ Landlord's phone:_____________________
May we contact your landlord to verify that you may have a dog on your property?:
Yes ____ No ____
May we visit your home before and after you adopt a dog?: Yes ____ No ____
HAVE YOU OWNED A BOXER BEFORE? Yes ____ No ____
When?____________________________________________________________________________
What happened to it?
________________________________________________________________
Age/Cause of death
_________________________________________________________________
OTHER PETS OWNED IN THE PAST: _________________________________________________________________________________
What happened to them?
_____________________________________________________________
ANIMALS IN HOUSEHOLD NOW? Yes ____ No ____
Please list them along with ages and if they are spayed or
neutered
Dogs_____________________________________________________________________________
Cats_____________________________________________________________________________
Other____________________________________________________________________________
ADULTS IN HOUSEHOLD ___________________________Work hours: ______________________
CHILDREN IN THE HOUSE? Yes____ No ____
Sex/Age:____________________________________________________________________________
Sex/Age:____________________________________________________________________________
Sex/Age:____________________________________________________________________________
PRIMARY CARE
Who will feed and exercise the dog? _______________________________________________________
How will the dog be exercised? ___________________________________________________________
Who will care for the dog in your absence (vacation, emergencies, etc. ____________________________
___________________________________________________________________________________
VETERINARIAN: _____________________________________ PHONE:
________________________
Why are you interested in owning a
boxer?___________________________________________________
____________________________________________________________________________________
How much money would you consider to be a major medical expense? _____________________________
REFERENCES Please provide the names and phone numbers of two people
we could contact
1) __________________________________ Phone ____________________________
2) __________________________________ Phone ____________________________
ADDITIONAL INFORMATION
Dogs will be housed? (Circle one) Indoors Outdoors Where when alone? _________________________
Have you ever taken a dog to obedience training? Yes ____ No ____
Are you willing to take obedience classes? Yes ____ No ____
Have you ever crate trained a dog? Yes ____ No ____
Are you willing to crate train? Yes ____ No ____
Do you own a crate? Yes
____ No ____
Brand _______________________________ Size_____________________________
Any additional information you would like to share about owning a boxer:
How did you learn about Boxer Rescue?
Directions to your home:
__________________________________________________________________________
(For Missouri Valley Boxer Club Rescue use only)
Call taken by:
____________________________________________________________________
Caller referred
by:_________________________________________________________________
Dogs discussed:
_________________________________ Date:
___________________________
Dog seen:
______________________________________ Date:
___________________________
Home interview
completed by ______________________________________
Date:____________
NOTES:
Dog adopted:
___________________________________ Date:____________________________
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