Black Hills Boxer Rescue
Rapid City, South Dakota
http://www.blackhillsboxerrescue.org
bhboxerrescue@aol.com
Adoption Application
We realize this Application is very long, but we hope you understand the importance
of each and every question. Your answers to these questions help us determine the
best homes for our Rescue Boxers, and the best Rescue Boxer for your Family.

By applying for the adoption of a Rescue Boxer from Black Hills Boxer Rescue,
you hereby give your Veterinarian (s),references and Animal Control Facilities
permission to disclose information to Black Hills Boxer Rescue.

Incomplete Applications will not be accepted. Please be thorough with
your answers. Please click on the "SUBMIT" button at the end of the
application.  If you wish to clear your answers, you may do so there as well.
Date:
Name/Names
Address:
Previous Address:
Email Address:
Phone Numbers:
Are you 21 or Older?
Do you live in a House, Trailer,
Apt., Other:
Do you own or rent:
Boxer Rescue requires a copy of Landlord statement/Lease
Agreement for Renters. Please provide Landlord's name and
telephone number above:
How many adults living in the
home:
How many children/ages:
(Veterinarian Reference is required)
Please provide
name/telephone/address for all
veterinarians used in the past 7
seven years:
Provide name/telephone for two
references not related:
May we visit your home and
contact your references to verify
the information you have provided:
List all pets currently living in the
home (species, breed, age, sex,
inside or outside pet)
Are all the pets spay/neutered,
current on vaccinations, heartworm
preventative and licensing? If not,
please explain why:
List all the pets you've had in the
past 7 years.  Were they
spay/neutered, inside or outside
pets, what happened to them?
Are you now or have you been
involved in breeding, showing or
agility?  If you have bred, please
list number of litters and dates:
List the rescue boxer or boxers
you are interested in:
Why do you think your home is the
right home for this particular dog:
Why are you coming to rescue for
your boxer? Example:cheaper,
already trained, want to help a
needy dog etc:
How hours will boxer be left alone
during the week:
Where will boxer be kept when
home alone? ie; indoor crate, run
of house, garage, outside kennel,
yard etc:
Where will boxer be kept when
family is home? Where will boxer
sleep:
Do you have a fenced yard?
Please describe fencing ie: does it
enclose yard, height, chain link or
wood, how many gates:
If no fencing, how will toileting and
exercise be handled? Describe
what you'll do in inclement weather:
Are you opposed to the use of an
indoor crate, if so, please explain:
Are there any special activities you
would include your boxer in:
What do you expect basic yearly
vet expenses to cost?  List what
you'd have done:
What plans do you have for
catastrophic vet care?ie; bloat
surgery, ACL tears, broken limbs
etc. Care that could cost up to
$2000 or more:
What brand of dog food will you
feed? Will it be scheduled feedings
or free feeding:
What behaviors do you expect
your rescue dog to display the first
couple weeks in your home:
What behaviors do you find
unacceptable, and what would you
do about them:
Some boxers had owners that did
not put any time into them. Are you
comfortable house and basic
obedience training:
What reasons would you return a
boxer to rescue:
What would you do if the boxer
chased your pets, was destructive
or got into the garbage:
Have you ever sold; given away; or surrendered an
animal to an animal shelter, rescue or other party? If
so, provide date(s), city/state, name of shelter or
rescue and specific circumstances:
What are the requirements for dog ownership in
your community (licensure, how many you can have,
leash laws etc?) (If you don't know, please call and
find out so you can answer this question) Do you live
in a neighborhood that has covenants on the size or
breed of dog you can have?
Has anyone in your household ever been convicted
of a charge relating to cruelty to animals or child
abuse?
Is there any such charge pending?
Has any such charge ever been filed?
Agreement


If you adopt a dog elsewhere or find another dog to foster during
this review process, please notify BHBR immediately so we can
stop work on your application.

Thank you for taking the time to complete this application. We
also thank you for wanting to adopt an animal instead of buying
one. By adopting, you can save a life.


Please answer yes or no to each following question.



Do you agree to the following:
Keep current license and ID tags on dog at all times?

Agree to keep rescue dog on leash whenever it is not in a contained or
fenced area?

Agree to never transport dog in open back of a pickup?


Return dog to Boxer Rescue if you can no longer keep or care for dog?


Allow Boxer Rescue agent to visit your home prior to or after adoption?
Type Yes or No
Signature Waiver
: A) I agree that by typing my name is the same as signing my name to
this legal document. B) I give permission for the Boxer Rescue Agent to
type my name to this document, causing it to be same as my legal
signature on this document.

Application Usage: Please type YES/NOf you do or do not want your
application shared with other Boxer Rescues for the purpose of
adopting or fostering a boxer.

Financial and Physical: I hereby testify that I am financially and
physically able to care for this dog. I understand that proper food,
veterinary care, bedding, toys, crate and so on 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.

Truthfulness: I understand that if the information contained herein is
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.
Yes/No Sharing
By signing/typing (electronically) below, you attest to the truthfulness of your answers.
Falsification of any of the above information will be grounds for denying/rejecting your
application. This is a RELEASE OF INFORMATION FORM. You are giving us permission
to contact your veterinarian and discuss your records, you are giving permission to contact
any organization that is necessary to confirm your answers. To include, animal control
agencies, humane societies, rescues etc.
Applicant Signature/Date
 CoApplicant Signature/Date
Any Additional Comments or
information you would like to provide,
do so here::

*****************************************************************************************************************************
FOR BOXER RESCUE USE
Date application received by Boxer Rescue:
Comments:


APPROVED:
DISAPPROVED:
Boxer Rescue Representative: