Clone of Southern Magnolia Boxer Rescue - Dog Adoption Application

Southern Magnolia Boxer Rescue Application for Adoption

We reserve the right to deny any application for any reason. We advocate for the animals in our care and do our best to insure each animal is placed in the best home situation. Owning a dog is a commitment with a variety of responsibilities; if you cannot meet those responsibilities, neither you nor your dog will be happy. It is our policy to make certain that each person who adopts a dog is aware of the responsibilities of pet guardianship, and is able and willing to accept those responsibilities morally, physically and financially. By completing this questionnaire, you will aid us in determining if you and your family are ready for pet guardianship, and if the dog of your interest would suit you and your lifestyle.
Note:

We require that interested adopters fill out an application before meeting a dog. Our group is run completely by volunteers who have full-time jobs and families but freely donate their time and money to help save dogs that others have rejected. While filling out this application does not obligate you to adopt a pet, please assist our efforts by only filling out this application if you are ready to accept a dog into your home now and willing to drive to our location in Mississippi to meet and/or pick up your new pet.
Name of animal*
Name of animal you are interested in adopting
Applicant/potential adopter information
Name of Applicant*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
Home Number

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Birth Date*

MonthDayYear
Occupation and employer*
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Name of spouse, partner, significant other or roommate

First NameLast Name
Relationship to you
His/her Phone Number

Area CodePhone Number
His/her Cell Phone*

Area CodePhone Number
His/her occupation and employer*
About your household...
Where do you live?*

Single Family HomeApartmentCondoMobile Home
How long at address?*
If renting, do you have your landlord's permission to have a pet?

YesNoHave not asked yet
Please list number of children in the household and their ages.*
Enter NONE if you have no children
Is anyone home during the day?*

YesNo
Do you have a yard?*

YesNo
If yes, is it fenced?
How high?
How would you best describe your household? Check all that apply*

EnergeticQuiet, peaceful, calmBusy and loudVery structuredCasual, laid back
Does anyone in your household smoke?

YesNo
If yes, do you smoke in the house or outside? (Being a smoker does not necessarily disqualify you as an adopter but certain breeds that are prone to allergies and have a narrow nasal passages do not do well in a household that has an indoor smoker.)
Your companion animals...
Please list ALL the pets currently in your household, their type and ages. Please include dogs, cats, birds, etc.*
Enter NONE if you do not have any other pets.
Are all your animals spayed or neutered? If necessary, please explain.*
Enter NA if you do not currently have pets.
Where do your current pets stay?*
Enter NA if you do not currently have pets.
Have you ever trained a dog in obedience classes?*

YesNo
Have you ever kept a dog on a chain or outside in a pen?

YesNo.
If yes, please explain.
Your new dog...
What is your primary reason for wanting to adopt a dog?*

CompanionGuard DogWatch DogFightingHuntingAttack DogGift for KidsGift for Spouse or FriendOther
If other, please explain.
Why are choosing to rescue a dog instead of purchasing one from a breeder or store?*
It is important to adopt a dog who is a good fit for your lifestyle. Some dogs love to lounge around, some love walks, some love to snuggle. Tell us a little about how you envision life with your new dog?*
How many hours a day will your dog be alone?*
Where will the dog be when he/she is left alone?*
Where will the new dog be kept when you are at home?*
Where will your new dog sleep? Please be specific. For example, on a dog bed in the living room, on the floor in my son's room, etc.*
Will you allow your new dog on the furniture?*

YesNoOn some furniture but not all
What do you know about heartworms and flea control?*
If necessary, would you be willing to attend obedience classes at your own expense?*

YesNo
Do you travel a great deal?*

YesNo
When you do travel, how will you provide for your dog when you are gone?*
How would you be affected if your dog needed surgery or special medical care that would cost in excess of $500?*

It would be a strain financially and might put me in debt.I could handle it, but I'd have to make some adjustments.It would pose no problem financially.I would give the dog away or put it down.
How much do you expect to pay in yearly vet fees?*
Under what circumstances would you not keep your new dog?*

DivorceIllness in the familyMovingNew babyNew jobHousetraining problemChewingBarkingDiggingAllergyShedding too muchDog grows too bigDog becomes illKids ignore the dogDog does not get along with other petsNot obedient enoughWould not give up for any of the aboveOther
If other, please explain.
If your new dog becomes too destructive in your home what would you do?*
If the new dog has "accidents" in your home, what will you do?*
Under what circumstance would you tether a dog to a chain, rope, lead line or confine him/her to a pen?*
Please provide 2 personal references, (other than family members), and veterinarian information...
Family Veterinarian*
Phone Number*

Area CodePhone Number
Personal Reference 1 - Other than family members
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship to you*
Personal Reference 2
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship to you*
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Southern Magnolia Boxer Rescue Application for Adoption

Note:

Applicant/potential adopter information

About your household...

Your companion animals...

Your new dog...

Please provide 2 personal references, (other than family members), and veterinarian information...

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