Cedar Valley Boxer Rescue

Temporary Evaluation Home Application

No.__________

Name: _______________________________________________________________Date: _______________________

Address: _________________________________________________________________________________________

City: ______________________________________________State: _______________________ Zip: ______________

Phone (home, work, Cell): _____________________________________ email: _________________________________

Date you could accept a Rescue Dog: ________________ Number of dogs you can accept at one time: ______________

List any limitations you may have with accepting a Rescue Dog: _____________________________________________

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1)   Are you a member of Cedar Valley Boxer Club? _______________________ If so how long? ___________________

2)   If your are not a member, would you like to be? _______________________________________________________

3)   Who from the club will be your sponsor? _____________________________________________________________

4)   Why do you want to be a temporary home evaluator? _________________________________________________
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6)   What kind of experience or knowledge do you have with Boxers? _________________________________________

7)   What kind of experience or knowledge do you have with rescue? _________________________________________

8)   Would you be willing to temporarily keep a Boxer that requires special care due to physical handicaps or special
medical care? _________________________________________________________________________________

9)   Would you be willing to temporarily keep a Boxer that requires extra time and patience to overcome some training or minor behavior problems? ________________________________________________________________________

10) What are your views on training and working with behavioral problems? ____________________________________

11) Are you aware of the responsibility and commitment a rescue dog will demand? ______________________________

12) Are you able and willing to accept some of the financial burden of caring for a rescue Boxer? ___________________

13) What is the name of your vet? _____________________________________________________________________

14) How many people are in your household? ______________ Ages? ________________________________________

15) Are there other Boxers or pets in your home? __________________If so list what age & sex: ___________________
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16) Will someone always be home to attend to the rescue dog? _____________________________________________
if not, how long would they be alone? _______________________________________________________________

17) Where will the rescue dog be kept? _________________________________________________________________

18) Do you have a fenced yard or kennel run? ___________________________________________________________

19) Do you plan on crating the rescue dog? _____________________________________________________________

20) Can you accept a dog that cannot be crated? _________________________________________________________

21) Do you have the necessary supplies to care for a rescue dog? ___________________________________________

22) What food do you plan to feed? ____________________________________________________________________

23) What other information or supplies would you need to accommodate a rescue dog? ___________________________

24) Do you have any questions regarding being a rescue dog evaluator? ________________________________________

25) Would you be interested in helping in other Boxer rescue activities? ________________________________________

Other comments: ___________________________________________________________________________________
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Signature: _____________________________________________ Date: __________________

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