DATE:

NAME:

ADDRESS:

CITY:

STATE:

ZIP CODE:

PHONE:

DONATION:   (non-refundable)

I AGREE TO CONTINUE WITH ALL INFORMATION PROVIDED ABOVE.

. WHITE BOXER RESCUE . QUESTIONNAIRE (PLEASE ANSWER ALL QUESTIONS THAT APPLY)

 PLACES OF EMPLOYMENT WITH PHONE NUMBERS:

 WORK SCHEDULES:

DO YOU LIVE IN:
1. A house in the country.
2. Single family house.
3. Townhouse condo
4. Apartment.
5. Trailer.

DO YOU
1. Own
2. Rent

   ARE YOU PLANNING ON MOVING WITHIN THE NEXT YEAR?

   HOW MANY PEOPLE LIVE IN YOUR HOME?

   DO YOU HAVE A DOG OR DOGS NOW?

   HOW MANY? BREED/BREEDS? AGES? NAMES? GENDERS?

   OR HAVE YOU OWNED DOGS IN THE LAST 5 YEARS?

   WHAT BREED(S)?

   WHAT HAPPENED TO YOUR LAST DOG?

   DO YOU OWN OR HOUSE ANY OTHER ANIMALS?

   LIST SPECIES AND NUMBER

   ARE YOUR CURRENT DOGS SPAYED OR NEUTERED?

   YOUR VETERINARIAN, PRESENT OR PAST?

   ADDRESS AND PHONE NUMBER?

   DO YOU HAVE A FENCED YARD?

   IF YES WHAT SIZE?

   IF NO ARE YOU PLANNING TO?

   HOW DO YOU PLAN TO EXERCISE A DOG?

   DO YOU HAVE A DOG CRATE?

   IF YES WHAT SIZE?

   HOW LONG WOULD DOG BE KEPT IN CRATE DAILY, IF AT ALL?

   DO YOU HAVE OUTSIDE KENNELS?

   DO YOU BELONG TO ANY TRAINING OR KENNEL CLUBS?

   WHICH ONES:

   WOULD YOU ADOPT A DOG WITH A TREATABLE HEALTH CONDITION?

   WOULD YOU CONSIDER A SPECIAL NEEDS DOG? (DAILY MEDS, DEAF, ETC.)-

   WOULD YOU ADOPT A DOG WITH A DISABILITY? (AMPUTEE, HEART CONDITION, ETC.)

   WHO WILL CARE FOR YOUR PET DURING VACATIONS?-

   WHAT WILL YOU DO IF YOUR DOG IS DESTRUCTIVE WHILE LEFT ALONE?-

   WHAT IS YOUR DEFINITION OF DISCIPLINING A DOG?-

   ARE YOU NOW OR HAVE YOU BEEN, IN THE PAST, A BREEDER? PLEASE EXPLAIN-

   PLEASE LIST TWO REFERENCES - name address phone

   (No more than one relation)

   1.

   2.

   DO YOU HAVE ANY CHILDREN?

   IF YES, HOW MANY?

   PLEASE EXPLAIN WHY YOU ARE INTERESTED IN A BOXER? in paragraph form:

   WHAT AGE BOXER ARE YOU INTERESTED IN?

   WOULD YOU TAKE ANY OTHER AGE?

   MALE OR FEMALE?

   COLOR?

   WHAT ARE YOUR PREFERENCES FOR A DOG - IF ANY, SUCH AS doesn't get on furniture, must like cats, good with children and so on....

   AFTER EVALUATION OF YOUR COMPLETED APPLICATION, IF RESCUE IS CONSIDERING
   YOU FOR AN ADOPTION, RESCUE WILL CONTACT YOU TO SCHEDULE A PROPERTY
   INSPECTION. IF YOU ARE APPROVED AND LIVE MORE THAN 100 MILES FROM RESCUE, THERE WILL BE A TRAVEL CHARGE OF $50.00. SPECIAL TRAVELING ARRANGEMENTS AND FARTHER DISTANCES WILL BE NEGOTIATED. THANK YOU FOR YOUR INTEREST IN WHITE BOXER RESCUE

   CONNIE AND DAN DOMERACKI

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