Shirley's Angels Boxer Rescue

SHIRLEY'S ANGELS BOXER RESCUE

ADOPTION APPLICATION

Email this application to us: [email protected]

Type of Dog Requested: Male Female

If showcased on our website, what is the animal’s name or number?

Would you adopt a dog over 3 years old? Yes No Over 5 years? Yes No

The animal described above a preference required

Personal Information:

Applicant’s Name:

Age: (must be 21 years or older to adopt a dog)

Applicant’s Work Phone Number:

Applicant’s Home Phone Number:

Applicant’s Cell Phone Number:

Applicant’s Address:

City/State/Zip:

Applicant’s Email Address:

Applicant’s Employer:

Position:

Employer’s Phone:

Co-applicant’s Name:

Age: (must be 21 years or older to adopt a dog)

Co-applicant’s Work Phone Number:

Co-applicant’s Home Phone Number:

Co-applicant’s Cell Phone Number: Co-applicant’s relationship to Applicant:

Spouse Parent/Guardian Child Roommate Other:

Co-applicant’s Address:

City/State/Zip:

Co-applicant’s Email Address:

Co-applicant’s Employer:

Position:

Employer’s Phone:

Are you currently expecting a child? Yes No

Are you contemplating/planning children in the next 10 years? Yes No

Would the arrival of children affect your decision/commitment to love and care for your dog? Yes No

Are you willing to take responsibility for a dog for the next 10 years or more? Yes No

Average number of days applicant is out of town per month (business or pleasure): 0 1 to 3 4 to 6 more than 6

Household Information:

Do you live in a: House Townhouse Apartment Condo

How long have you lived in your current residence?

Do you: Own Rent

If you rent, have you discussed having a dog with your Landlord? Yes No

Landlord’s Name: Phone Number:

Do you have a fenced yard: Yes No

If yes, what type and how high?

If no, how will you keep your dog in the yard?

List all residents of the household (other than applicant or co-applicant): Name: Age: Name: Age: Name: Age: Name: Age:

Does anyone in your family suffer from allergies? Yes No Allergies to cats? dogs?

If you have children, what has been their exposure to dogs? None Some A lot

Type of exposure: With a small dog With a large dog

Is anyone home during the day? Yes No

How many hours per day will the animal be left alone and where will dog be during that time?

General Questions:

Have the applicant and co-applicant discussed and agreed to adopt from a Rescue? Yes No

Have all other residents of the home agreed to caring for and loving your adopted dog? Yes No

Who will be responsible for the dog?

Indicate reason(s) why you want to adopt:

All animals will be spayed/neutered. Do you have any reservations or questions about this? Yes No If yes, explain:

Where will the dog be kept during the day?

Where will the dog be kept at night?

Crate Use: No Crate Reluctant to Crate Crate if Necessary Temporarily Crate Permanently Crate

What method of housetraining do you plan to use?

How much do you think it will cost to take care of this animal each year (food, vet bills, license)?

How will your dog be cared for during the times when the responsible parties are out of town (business, vacation)?

If you move what will you do with your pet?

Have you/someone in your family ever dropped off an animal or released an animal to an animal shelter or humane organization? Yes No If so, when & why?

Pet Experience: Have you ever owned a dog? Yes No Have you ever housetrained a dog? Yes No Have you ever crate trained a dog? Yes No Have you ever obedience trained a dog? Yes No Please list all pets you have owned in the past five (5) years: NONE

Cat Dog Male Female Age (neutered/spayed: Yes No) Indoor Outdoor Name Currently lives where?

Are your pets up to date on vaccinations and licenses, etc? Yes No Not Applicable

Do you have a veterinarian? Yes No

If yes, who is your veterinarian? Phone number:

If no, what are your plans for finding a veterinarian for your new pet?

If you ever have had a pet die at an early age or due to an accident, please give details:

How will you exercise the dog?

Who will supervise all outdoor activities?

Please use this space for additional comments if any.

References:

Please provide names and phone numbers of two references (good references include vets, rescue volunteers, friends who know your pet history, neighbors, etc.):

Name: Phone: Cell Phone: Relationship to you:

How did you hear about the animal that you are interested in?

Please give specific directions to your home. Our group requires a home visit before adoption.

In lieu of that home visit, we can accept digital photos of your home & yard (at their discretion). Can you provide digital photos via email to us? Yes: No: I ACKNOWLEDGE THAT ALL THE INFORMATION ON THIS FORM IS TRUE AND CORRECT. I UNDERSTAND THAT ANY MISREPRESENTATION OF FACT MAY RESULT IN THE REMOVAL OF THE ADOPTED DOG FROM MY HOME BY SHIRLEY'S ANGELS BOXER RESCUE.

I FURTHER ACKNOWLEDGE THAT AT ANYTIME NOW OR DURING THE LIFE OF THIS DOG, IF I CAN NOT OR DO NOT WANT TO KEEP THE DOG, I WILL RETURN IT TO SHIRLEY'S ANGELS BOXER RESCUE ONLY, AND NOT TO ANY OTHER PLACE. ALL MONIES DONATED TO ANIMAL RESCUE FOR ADOPTION OF THIS DOG WILL BE FORFEITED IN INSTANCES OF RETURN OF ANIMAL.

I ACKNOWLEDGE THAT IF THIS APPLICATION IS APPROVED, I WILL HAVE SAID ANIMAL SPAYED/NEUTERED BY THE AGE OF SIX (6) MONTHS AND SEND PROOF OF THAT SPAY/NEUTER TO SHIRLEY'S ANGELS BOXER RESCUE, WITHIN TEN DAYS OF THAT PROCEDURE. FAILURE TO DO SO CAN RESULT IN THE ANIMAL BEING RETURNED TO & MONIES WILL BE FORFEITED.

THERE WILL BE A $150 ADOPTION FEE AT THE TIME OF ADOPTION ON UNALTERED PUPPIES and/or PREVIOUSLY ALTERED DOGS AND A $225.00 ADOPTION FEE FOR DOGS THAT WERE ALTERED BY SHIRLEYS ANGELS BOXER RESCUE.

NOTE: THE ADOPTION FEE COVERS ALL VETTING TO DATE OF THE COMPANION ANIMAL. THE COMPANION ANIMAL IS CURRENT ON ALL VACCINATIONS, SPAYED/NEUTERED, ON HEARTWORM PREVENTATIVE AND FLEA/TICK PREVENTATIVE. NO ADOPTION IS COMPLETE UNTIL ANIMAL HAS BEEN ALTERED. ALL MONIES WILL BE FORFEITED IF ANIMAL IS RETURNED. THE ADOPTING PARTY RELEASES SHIRLEY'S ANGELS BOXER RESCUE FROM ANY AND ALL LIABILITY ARISING OUT OF OR IN ANY WAY CONNECTED WITH THE ADOPTION OF THIS COMPANION ANIMAL.

A HOME INSPECTION IS REQUIRED FOR ALL ANIMALS ADOPTED FROM SHIRLEY'S ANGELS BOXER RESCUE. IF AT TIME OF INSPECTION, CONDITIONS ARE NOT ACCEPTABLE TO SHIRLEY'S ANGELS BOXER RESCUE, ANIMAL CAN/WILL BE RETURNED TO ANIMAL RESCUE. I CERTIFY THAT I/WE HAVE NEVER BEEN CONVICTED OF ANIMAL CRUELTY, NEGLECT, OR ABANDONMENT.

WITHIN 72 HOURS OF ADOPTION, PET MUST BE SEEN BY A VETERINARIAN TO RECEIVE EXAMINATION AND DISCUSSION OF FURTHER VACCINATION REQUIREMENTS.

I understand the above mentioned requirements and agree to comply. Failure to do so can result in the animal being returned to SHIRLEY'S ANGELS BOXER RESCUE..

Signature (Applicant/Co-applicant): Date:

I understand that by checking here, I am providing a digital signature.