BBR Adoption Application             First Name: Last Name: Address:   City: State: Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Deleware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshiire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming Zip Code: Telephone Number: Cell Number: Email: Date of Birth:       Preferred method of contact: Home Phone Cell Phone Email Best time to reach you at:: Morning Afternoon Evening Are you employed: Full-time Part-time From Home No If yes, please provide your typical daily schedule:   Are you a student: Full-time Part-time Telecourse/Internet No If yes, please provide your typical daily schedule:   Occupation:   Employer: Address:   Telephone: Length of employment:         Marital Status: Married Single Divorced Widowed Residing with Partner Partner's Name:   Date of Birth: Is your partner employed: Full Time Part Time From Home No   If yes, please provide a typical schedule: Is your partner a student: Full Time Part Time Internet No   If yes, please provide a typical schedule: Occupation:   Employer: Address:   Telephone: Length of employment:               Do you have minor children (under the age of 18) ? Yes No If yes, please list children's names and ages:   Is there anyone else residing in your home? Yes No If yes, please explain:   Does anyone in your household have special needs (i.e. developmentally or physically disabled): Yes No If yes, please explain:   Are all members of the household in agreement regarding this potential adoption: Yes No If no, please explain:   Housing: Single-family Two-family Condo Apartment Mobile Home   Do you: Own Rent Years at present address: If less than 5 years, list previous address: If you rent, please provide name of landlord/management company: Address:  Phone Number: * Please note: If you are renting, BBR will require a copy of your lease agreement stating that you are permitted to have pets prior to the final adoption   agreement being signed. BBR will also require proof of any pet deposits paid prior to the adoption agreement being signed.   Do you have a fenced yard or area? Yes No If yes, please explain type of fencing and approximate dimensions of the area:   Do you currently own a dog or dogs? Yes No If yes, please provide breed, sex, and age:   Are your current dogs spayed or neutered: Yes No If no, please explain:   How many dogs have you owned in the last 10 years that are no longer in your household: Please explain the status of these dogs:   Do you have any other household pets? Yes No If yes, please list types of animal(s) and their housing arrangements: Are your current pets been socialized and/or dog friendly? Yes No   Are your current dogs up-to-date on their vaccinations: Yes No Are your current dogs up-to-date on their heartworm testing/preventative: Yes No If no to any of the above, please explain:   Please provide the following information for the veterinarian that has seen your pet(s):     Name:       Name of Clinic:       Address:       Telephone Number:       Last Appointment:       Reason for Visit:               If you have switched veterinarians for your current pets, please provide:             Past Veterinarian:       Telephone Number:     Reason for Changing Veterinarians:         Where will your Boxer be kept during the day? Indoors Outdoors Crate Other If other, please explain: Where will your Boxer be kept at night? Indoors Outdoors Crate Other If other, please explain: Where will your Boxer be kept while you are away from home (shopping, etc): Indoors Outdoors Crate Other If other, please explain: Where will your Boxer be kept when you travel: Family Friends Boarding Kennel Home with Sitter     How many hours per day will your Boxer routinely be alone: If longer than 4 hours, please explain the provisions you will make for your Boxer for elimination(bathroom) purposes, feeding and exercise:     Are you willing to purchase a crate and properly crate train the Boxer: Yes No If no, please explain: Who will be responsible for:           Feeding and watering:     Grooming:     Training:     Exercising:               How do you plan on exercising the Boxer:   Are you willing to take the Boxer to obedience class: Yes No If no, please explain how you will handle training: Please describe any training you have done with your past and present dogs, either formally or on your own:   Are you aware that it costs $400-$700 per year to raise a healthy Boxer: Yes No Are you aware that emergency medical treatment can cost up to or over $2000: Yes No Are you financially prepared to raise a Boxer and provide emergency treatment if and when necessary: Yes No Are you aware that a Boxer can live from 8-15 years: Yes No   Have you researched the breed prior to making the decision to adopt a Boxer: Yes No If yes, have you utilized: Books/Magazines Internet Video Past/Present Owners Combination   Do you prefer: Male Female No Preference   Please explain: Do you prefer: 6-18 months 18 mo - 2 yrs 3-5 years 6+ years No Preference   Please explain: Do you prefer: Fawn Brindle White No Preference   Please explain: Do you prefer: Cropped Ears Natural Ears No Preference   Please explain:       Are you willing to adopt a deaf Boxer: Yes No If yes, please explain any past experience with a deaf dog: Are you willing to adopt a blind Boxer: Yes No If yes, please explain any past experience with a blind dog: Are you willing to adopt a special needs Boxer: Yes No If yes, please explain any past experience with a special needs dog:       Please provide a brief summary of your knowledge and/or experience with the Boxer breed: Pleae explain why you have chosen the Boxer breed: Please include any additional remarks or questions that you may have:   I give my permission to any representative of BBR to obtain veterinary records. Agree I certify that the answers contained in this application are true and I realize that any false or misleading information will result in the nullification of this adoption process.