Cedar Valley Boxer Rescue

Adoption Home Evaluation

No.__________

This questionnaire is prepared for benefit of both the dog and the prospective owner. It will enable us to place the right dog with the right prospective owner.

Name: ___________________________________ Address: _______________________________________

City: ________________________________ State: _______________________________ Zip: ___________

Phone (home, work, cell): _________________________________ email: ____________________________

Occupation: ________________________________________

  1) Why do you want a Boxer? _______________________________________________________________

  2) Have you ever owned a Boxer? ____________________________________________________________

      What happened to him/her? _______________________________________________________________

  3) Do you have a fenced yard? _______________________________ Height, Length: __________________

  4) Will the Boxer be kept indoors or outdoors? __________________________________________________

  5) Do you have other pets? _____________ What kind & sex? _____________________________________

  6) Does everyone in your family want a Boxer? _________________________________________________

  7) What sex of dog do you prefer? ____________________________________________________________

  8) Will you keep the Boxer on Heartworm Preventative? __________________________________________

  9) Do you have a veterinarian to care for the Boxer? ______________________________________________

10) Will you keep the dog's vaccinations up to date and take the dog in for annual exams? _______________

11) How did you find out about our program? ____________________________________________________

12) Your comments and suggestions: ___________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

                     Your Signature: ______________________________ Date: ______________

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