Incomplete Applications will not be accepted.

Applicant Information:

First Name:
Last Name:
Occupation:

Co-Applicant Information:

Address Information

Current Address:
City:
State:	AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY         Zip Code:

What area of town do you live in? Central AustinNorth AustinSouth AustinEast AustinWest AustinOutside of AustinSuburbs South of AustinSurburbs North of AustinSan Antonio

-  -		-  -
Home Phone Number		Alternative Phone Number

Email Address:

Home Information

Number of Adults: 

Number of Children: Ages of Children:

Are there members of your family who need special consideration? yes no
If yes, please explain:

What type of dwelling do you live in? House Apartment Duplex Other

If other, please explain

Do you rent or own? rent own

Landlord Name:     
Landlord Phone:  -  - 

Length of time at this address:

Facility and Training Information

Do you have (check all that apply) 
Fenced Yard?
Kennel Run?
Locks on Gates? 
No Response

What type of lock is on your gate?

Describe the yard or facility in detail:

 

 If you don't have a fenced yard, describe how you will exercise your dog:

If you don't have a fenced yard, where will your dog use the restroom:

How many hours will your dog spend alone each day?
 
Are you required to travel for work? yes no

Will the dog have a facility or care taker when you travel? yes no

Where will the dog spend most of the day?inside outside

Where will the dog sleep? inside outside

Will you crate train the dog? yes no
If no, please, explain:

 
What level of cost would you consider a major medical expense?
 
What type of behavior are you not prepared to tolerate or work with from your dog?

 Pet Information

Please list the number dogs and breeds that you have owned over the last five years.

 
Please, list any pets you currently have including breed, age, gender (cats and others).

 
Have you ever given up an animal? If so, please, explain why?

 
Are all of your animals spayed or neutered?yes no
If not, please, explain?
 
Are all of your pets' vaccination and heartworm preventatives current? yes no

If yes, what kind of Heartworm preventative does your dog take?
 

Vet Information 

Vet Name
Clinic Name
Phone Number:	-  -

 
  
 I agree to allow the above listed veterinarian to release information about the care of my pets to a representative of Austin Boxer Rescue:  yes no

Preferences

Please, explain in detail, why you want to adopt a Boxer.

 
If there are a specific dogs that you like, please list their names below in the order of your preference.

 
Gender: no preference female male
 
Preferred Coloring: "Check all that apply"
no preference
fawn
brindle
reverse brindle
white 

Age Range: no preference 0-1 year 1-3 years 3-5 years over 5 years 

About You

Where did you hear about us? personal referral web search web link petsmart other
 
If you heard of us through a personal referral or web link, please let us know where so that we can thank those who referred you.

 

Contract

Please read carefully

Adopter agrees to keep the dog identified above and assume all expenses and liabilities incurred.Adopter agrees to provide responsible humane care of the above mentioned dog proper veterinary care, yearly vaccinations and monthly heartworm preventative are a must. Proper precautions should be taken against theft, running away, the dogs well being should always be a prime concern. ABR retains the right to reclaim said dog (at no cost or obligation to ABR)at any time it is deemed by ABR that the adopter is remiss in caring for the dog. This shall include but not limited to: being left in an unsanitary environment, mental or physical cruelty, leaving the dog in a car during warm weather, tying up outside while gone, riding in the back of a pickup truck, walking the dog without a leash, failure to provide proper nutrition, housing, training and/or veterinary treatment Financial and physical: I hereby testify that I am financially and physically able to care for a dog, understand that proper food, veterinary care and other necessities can be costly and that I can meet these requirements. I further testify that I am physically fit to provide all necessary activity for the dog. If for any reason you are unable to keep said dog it is to be returned to ABR with a minimum of 21 days notice. Transportation back to ABR is the sole responsibility of the adopter: If the dog must come into rescue sooner and a foster home cannot be found the Adopter is responsible for all boarding and veterinary fees incurred in boarding. Under NO circumstances shall the Adopter place said dog with any person, rescue group, foster home, agency, or Humane Society. If after the 21 days ABR can not take back the dog, for whatever reason, adopter may place the dog after giving ABR an addition 7 days notice of intent to do so, further, adopter must provide ABR with information on potential placement and potential placement must go through ABR screening process. If no notification is given to ABR and it is found out that the dog has changed ownership, under the conditions of this contract the Adopter must pay ABR $500.00. Truthfulness: I understand that if the information contained herein is found to be false, my application will be refused or said adopted dog shall be relinquished to ABR without a refund of the adoption fee. Adoption fee statement: I agree that the adoption donation is NON-REFUNDABLE even if the animal is returned to ABR and that ABR is adopting not selling this pet to me. Adopter accepts the boxer "as is." Because of this, the adopter understands that ABR relinquishes responsibility if the boxer should become ill or die after being released to adopter or should bite, scratch, injure or cause the death of any person or animal or cause damage to property after being released into the adoptive home. Unless already agreed by ABR, all medical expenses are sole responsibility of Adopter. The Adopter hereby accepts possession of, title to (subject to the conditions of the adoption contract), and responsibility for the animal adopted. Further the adopter agrees to release and hold harmless ABR forever from liability for any injury or damages to any person or property caused by the adopted animal, and from any causes of action, claims, suits, or demands whatsoever that may arise as a result of such injury or damages. Signature waiver: I agree by typing my name below is the same as signing my name to this document, causing it to be a legal signature on this document


Signature waiver: I agree that by typing my name below, that I have read and understood the conditions of this contract.
Furthermore I agree to abide by the terms of this contract.

Applicant Signature
Date:	(choose one) JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC   (choose one) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   (choose one) 2008 2009 2010