Adoption Registration form

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityCounty

Posta CodeCountry

Phone Number*

Area CodePhone Number

Mobile Number

E-mail

Primary carer/owner Age?

Primary Carer/Owner Occupation?

Primary Carer /Owner hours worked?

Second Adult Age? (if applicable)

Second Adult occupation?

Second Adult Hours Worked?

Please select which best describes you

Single/live aloneMarriedLiving with partnerliving with people other than your partner

Number of Children and age

Number of visiting Children and age?

Are you expecting a baby or do you plan to have a baby in the future?

Do you..

Own your own HomeRentOther

If you live in a rented property do you have permission from the landlord to have a dog ( a written copy of the permission must be provided)

How big is your property i.e House, flat,

Do you have a garden and how big it is?

What type of fencing do you have around your garden and what is its height?

Have you owned a dog before?

YesNo

Have you owned Boxers before and if so how many?

If you have had dogs before what happened to them?

Do you have any other pets currently and if so what are they and what age?

If you have other dogs are they Neutured/spayed?

YesNo

Do you have a preference of gender

DogBitchI dont mind

Do you have a preference of colour

RedBrindleWhiteI dont mind

Preference of age if any

Would you be willing to offer a home to an older dog?

YesNoMaybe

Would you be willing to offer a home to a dog with behaviour problems that need work?

YesNoMaybe

How long would the dog be left for in a 24hr period?

Where will the dog be kept while it is left alone?

Where will the dog sleep at night?

Who will exercise the dog?

How often and how long will the dog be exercised for?

What type of area will the dog be exercised in? (woodland, parkland, beaches, farm etc)

Do you plan on taking the dog to training or using a behaviourist?

How do you plan to deal with any behavioural issues that may arise?

Do you have a holiday booked?

When you go away who will look after the dog?

Are you planning to move home?

Are you planning a change in work hours?

How would you describe your activity levels?

High/Very ActiveMedium/Quite activeLow/Couch potato

Do you have a lot of guests/entertain regularly?

Do you or the other carer have any ongoing or health/current medical conditions?

Name and address of vet

How will you fund any veterinary costs?

Do you plan to take out pet insurance

Signature

These details are only accessed by Trustees of Boxer Rescue Service (Southern) and are not shared with any external parties.

Adopt A Dog Form