Application
"Helping Boxers Go Another
Round"
Please fill out completely:
* Required Field
*
Your name:
*
Address:
*
City/State/Zip:
*
 Home Phone:
*
E-Mail:
Occupation:
Employer:
Work phone:
Work E-Mail
Name #2
Employer:
Occupation:
Work phone:
Work E-Mail
Personal Reference:
E-Mail:
Years Acquainted:
Phone number:
Address:
City/State/Zip:
Reference #2:
E-Mail:
Years Acquainted:
Phone number:
Address:
City/State/Zip:
Veterinarian:
Address:
City/State/Zip:
Phone number:
Do you live in a:
 House
 Apartment
Mobile Home
 Other
Do you:
 Own
Rent
Central NY Boxer Rescue requires a copy of Landlord
statement/Lease Agreement for Renters.
How long have you lived here:
Years
 Months
Do you have a fenced yard:
 No
Yes
If not, how will exercise/bathroom be handled:
How many adults in the home:
Children:
Are there any children under age 5:
No
Yes
Yes
 No
Do you own any other dogs:
How many:
Are they fixed:
Yes
No
Do you own any other pets/livestock:
 Yes
No
If so, specify:
What happened to your last dog?
Tell us your thoughts on crate training:
*
Have you owned a Boxer before:
 Yes
 No
Why do you want a Boxer:
In which dog were you interested?
What are your plans for the dog:
Pet
Guardian
Hunting
Schutzhund
 Agility
Other
Which would you prefer:
Doesn't matter
Mixed Breed
Purebred
Male
 Doesn't matter
Female
Doesn't matter
White
Fawn
 Brindle
Under a year
1-3 yrs.
 3-5 yrs.
Doesn't matter
Over 5 yrs.
Would you consider a dog with special
needs?
Yes
No
How many hours will the dog be alone each day:
Where will the dog spend most of each day:
Where will the dog sleep: