Address:

City: State: Zip: 

Home phone number: 

Work phone number: 

Other phone number: 

E-mail address: 

We DO NOT ship our puppies. Do you understand that you will be required to come to us and that several trips may be required? 
No 
Yes

Will you agree to a home visit by us?
No Yes

Applicants having only an electric/underground fence,
as their primary means of puppy yard containment,
will not be considered as a placement home.

If you answered NO to either of the two previous questions
DO NOT submit an application, you will NOT be approved!

Do you Own or Rent your home?
OwnRent

If you are renting, do you have permission from your landlord to have a dog and would you be willing to provide a document verifying this?
YesNo 

Why do you want a boxer? 

What is your gender preference?
male female no preference

What is your color preference?
fawn brindle no preference

What age boxer are you interested in?
Puppy Juvenile Adult No preference Would you consider a Rescue?

How long are you willing to wait for a puppy? 
1-3 months 3-6 months 1 year or less However long it takes

Who will be the primary caretaker? 

Have you owned dogs before?
Yes No

Please give a brief pet owning history below, i.e., health care, including heartworm preventative, vaccinations, etc., have you ever turned an animal over to a shelter or rescue and why, have you ever euthanized a dog and why, have you ever given a dog away and why?

Do you have a veterinarian? 
No 
Yes

Veterinarian's name, address, phone number and date of last visit: 

Do you have children? 
No 
Yes

Please give their ages and a brief history of their dog experiences below: 

Since a boxer is to become a full time member of the family, are all family members in agreement with acquiring a puppy and will each provide proper care? 
No 
Yes

Will you agree to spay or neuter your pet as we direct and provide us with proper documentation? (applies to "pet" placements) 
No 
Yes

Will you agree to a Limited AKC Registration? (applies to "pet" placements)
No 
Yes

Do you have a fenced yard? (Not having one will not automatically keep us from placing a boxer with you.) 
Yes - type of fencingChain link Privacy Other 
No - explain below how you plan to handle potty time and exercise?

Where will your dog spend most of his day? 
Crated 
Kennel Run 
In the House 
Other - explain below:

Do you understand that a Boxer is an INSIDE dog and they should NOT be kept outside and that we REQUIRE our pups must be kept indoors?
No 
Yes

Will someone be home with the new puppy during the first few days in your home?
No 
Yes

How many hours a day/night will the puppy be alone?   
1 2 to 4 4 to 8 8 to 10 10 to 12

IF NO, are you willing to learn to crate train your puppy? 
No 
Yes

Puppies are known to be somewhat destructive if not properly directed, do you agree to use a crate as instructed? 
No 
Yes

Do you plan to attend training classes with your pup at the appropriate age?
No 
Yes

Are you familiar with health problems associated with the Boxer?
No
Yes

Would you agree to our health testing guidelines prior to breeding your dog IF and WHEN ALL other breeding requirements have been satisfied?
No
Yes

If NO, please explain:

Although Boxers are short-haired, they do shed and sometimes slobber (especially when stressed, after drinking or when over-heated). Will this be a problem?
No 
Yes

Are you willing to work to overcome the ups and downs of owning and training a Boxer?
No 
Yes