Personal Information
*First Name
*Last Name
*Age
*Email
*Street Address
*City
*County
*State
*Zip
*Area code and phone #
Employment Information
*Occupation
*Employer
*Length of Employment
If less than a year, where did you work previously
Length of Employment
Are you or your spouse serving in the military?	Yes No
When is your next deployment?
Is there a possibility of an unexpected deployment?
Who will be responsible for the dog when you're gone?
What will you do if you are stationed overseas?
House Mates
Do other adults, other than yourself, live in your home?	Yes No
Adult 2's Name
Adult 2's Age
Relationship to you
Adult 2's Occupation
Adult 2's Employer
Will this person be one of the primary caretakers of the dog?
Please list any other adults living in your home. List name, age, sex, relationship, occupation. (if none then please state so.)
Children
Are there children in the home?	Yes No
Please list all children living in your home? (name and age)
Residence
Do you live in a	House Apartment Condo Other
If other please explain
Do you rent or own your home?	Rent Own
*How long have you lived at this address? (Please list in years in months)
If less than two years please list previous address?
How long did you live at this address?
Do you have plans to move within the next year?	Yes No
If you have plans to move, please explain.
*Even if you do not have plans at this time for moving in the future, what considerations would you make your for dog(s) and other pets should you find yourself needing to move from where you now live?
Rental Information (If applicable)
Dogs Permitted?	Yes No
Number of dogs permitted?
Weight Limit? (list in lbs.)
Amount of pet deposit required?
Landlord Name:
Landlord Address:
Landlord Phone Number:
Neighborhood and Fences
Do you have a fenced yard?	Yes No
What type of fence do you have?	Chain Link Privacy Other
If other please describe.
Is there a lock on the gate?
Do you have a kennel/run?	Yes No
If no fence/kennel run, how will exercise/toilet be handled?
*What are the requirements of dog ownership? (i.e. licensing, rabies, leash laws, and number of dogs you may legally have)
Other Animals
Do you currently have a pet?	Yes No
How many of each type of pet are currently in your home?
Dogs
Cats
Birds
Other
Please list all pets currently owned. List name, type (dog/cat/etc.), breed (if applicable, such as dog), age, sex, spayed/neutered or not.
If your dog(s) or cat(s) are NOT altered (spayed/neutered), please explain why. Please address each pet by name.
Are your cats declawed?	Yes No
Do you own livestock?	Yes No
List type, sex, age of livestock.
How is the livestock kept?
Have all other pets/livestock been around dogs, particularly medium to large dogs such as a Boxer?	Yes No
Are all pets/livestock current on immunizations and on prevention care?	Yes No
If pets/livestock are NOT up to date, please explain.
Veterinarian Information
Who is your current veterinarian:
Veterinarian Address:
Veterinarian Phone Number:
Name, phone number, city and state of any other veterinarians who have cared for your current pets:
*If you do not currently have a dog, what do you expect veterinary care will cost for a year?
Previous Pets
Have you owned dogs in the past 5 years?	Yes No
If so, what breeds of dogs?
What happened to these dogs?
Who was your veterinarian at that time?
Veterinarian address?
Veterinarian phone number?
Please provide the name of the dog and the client name under which the dog was listed with the veterinarian.
*If you've ever had to give a dog away, please give the details of the circumstances, and provide the name and the location of the person to whom the dog now belongs.
Boxer Preferences
*What made you choose the boxer breed?
*What made you decide to adopt a Boxer from a rescue organization?
Plans for this rescued Boxer?	Pet Guard Breed-Stud Other
If you choose other, Please explain.
*Boxer sex preference:	Female Male
*Boxer color preference:
*Boxer age preference:
Is there a color you would not want and why?
Do you have a strong preference about the dog's tail or ears?	Yes No
If so, please try to explain why you feel this way.
*Would you consider adopting a dog with a disability, such as a three legged dog or one with only one eye?
*Would you consider adopting more than one dog?
*Would you consider adopting a "senior" dog?
*What is the oldest dog you would consider adopting and why?
Day to day
*Where will the dog spend most of each day?
*Where will the dog sleep?
*How many hours will the dog be alone each day?
*Who will be in charge of the daily care of the dog?
*List your life activities in which you will enjoy including your dog.
*What arrangements would you make for the dog when you are away from home for an extended period, such as vacation or business trip?
*What feeding schedule do you plan to use?
Discipline, etc.
*What is your definition of disciplining a dog? Please provide examples.
*List types of dog behavior you consider NOT acceptable.
*What types of discipline have you found effective when your dog has been destructive or misbehaved?
*What will you do if your dog is destructive while left alone?
*Are you willing to attend obedience classes with your dog?
*Do you own a crate?	Yes No
*Even if you have never experienced the use of a crate with a dog in the past, would you be willing to use one if the dog that you and B.A.R.C. feels is best suited to your home needs one?	Yes No
If not, why?
*In what situations do you feel physical discipline might be effective?
*If any, what types of physical discipline might be effective?
*If approved and you adopted a Boxer from us, what measures would you take if your rescue dog had behavioral issues that you could not correct?
*What circumstances, in your mind, justify getting rid of a dog? Please be specific.
*At what point would you consider euthanasia?
Other Information
*Have you applied to adopt from, or volunteer with, any other rescue organization in the past two years?	Yes No
*Are you currently working with any other rescue organization?	Yes No
If yes to either of the above please list the name of the organization.
*Additional comments and/or information that you think might help us find the right Boxer for you, including more about your preferences and reasons for wanting a Boxer
*How did you hear about B.A.R.C.?
Boxers available from B.A.R.C., Inc. are located in foster homes throughout our region. Prospective adopters are required to visit the dog while he or she is in foster care to ensure that the dog is in a natural, relaxed, non-stressed setting when they meet.
*How do you feel about driving to see a foster dog? Would you be able to drive to meet a dog?
Do you agree to the following?
*Return the dog immediately to B.A.R.C. if you can no longer keep or care for the dog?	Yes No
*Allow a B.A.R.C. volunteer to visit your home prior to adoption?	Yes No
*I agree by initialing this line that typing my name is the same as signing my name to this legal document.
*I give permission for the B.A.R.C. agent to type my name to this document, causing it to be the same as my legal signature on this document.
*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.
*I understand that if the information contained herein is in any way found to be false, my application can be refused or said dog adopted shall be relinquished to Boxer Rescue without a refund of the adoption fee.
*I understand that the adoption fee is nonrefundable.
Permission to investigate
*By submitting this application to Boxer Aid & Rescue Coalition, Inc. I grant my permission to investigate my answers and contact anyone I have listed. I understand that any information obtained by B.A.R.C. during this process will not be sold or given to any third party without my permission.
*I understand that in order for my application to be considered I MUST answer ALL questions. I have reviewed my application and have answered all questions.	Yes No
Application Completion
*Signature
*Email
*Date
	* denotes required field

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Application form originally created by Greater Ohio Boxer Rescue. Adapted for BARC and used by permission.