Applicant Information Name Address City State - - Choose One - - Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Home Phone Cell Phone Age Occupation Work Phone Email Spouse/Partner Information Spouse/Partner Name Age Occupation Cell Phone Spouse/Partner Email Other Household Member Information If other adults in home, list name(s)/age(s): If children in home, list name(s)/age(s): Home Information Do you reside in: Condo/Townhouse Single Family House Duplex Apartment Mobile Home Do you: Rent Own If renting, please provide name and telephone number of landlord: How long have you lived at your current address? Is your yard securely fenced? Yes No Do you have a cable run? Yes No Current Pet Information Pet #1: Name Type/Breed Age Sex Weight Spayed or neutered? Yes No Pet #2: Name Type/Breed Age Sex Weight Spayed or neutered? Yes No Pet #3: Name Type/Breed Age Sex Weight Spayed or neutered? Yes No Additional Current Pets (list here, including if spayed/neutered) How many dogs have you owned in the last five years? What happened to your last dog? Lost Stolen Given Away Died Still Have Other Please explain circumstances (be specific): What breed of dog are you applying for? Have you ever owned this breed before? Yes No If not, why are you considering adopting this breed? Dog Preferences Age of dog wanted (Select all that apply) Under One Year Old One to Three Years Old Four to Six Years Old Seven Years or Older Gender wanted (Please choose one) Male Female Doesn't Matter Anticipated Plans & Daily Routine How many hours a day will the dog be left alone? Where will the dog spend most of the day? Where will the dog sleep at night? What will you do if your dog is destructive while left alone? List the types of behavior problems that you consider NOT acceptable: What is your definition of disciplining a dog? Please provide examples: Are you willing to attend obedience training with your dog? Yes No How will you exercise your dog? How often? Please explain in detail: General Information How far are you willing to drive to pick-up your new dog? (we do not meet part way, deliver or ship dogs) If you are currently working with any other rescue groups, list here: How did you hear about Second Chance Boxer Rescue? Friend/Family Petfinder.com Facebook Internet Search At Event What circumstances, in your mind; justify getting rid of a dog? Please be specific: Additional information or comments: Veterinarian Information Vet/Clinic Name City Phone Number Please check all boxes below. If any of the boxes are left unchecked, your application will NOT be processed. By checking this box, I am indicating that I am at least 21 years of age and that this is a valid and legal substitution for written signature on this legal document titled "Adoption Application".: Yes By checking this box, I understand that if the information contained herein is found to be false; my application can be refused or said dog adopted shall be relinquished to Second Chance Boxer & Friends Rescue without a refund of monies paid. Yes By checking this box, I understand that should I adopt from Second Chance Boxer & Friends Rescue, the adoption donation in its entirety goes toward the care for all of the rescue dogs and that this DONATION is non-refundable. Yes *NOTE: Be sure to check your email's Junk Mail/Spam mailbox as often our emails to you end up there.*