CBR Application

New Adoption Application

Name(Required)

First Last

Partner’s Name

Address(Required)

Street Address Address Line 2 City State ZIP Code

Cell Phone Number(Required)

Home Phone Number

Best Time to Call

Morning

Afternoon

Evening

Which FLORIDA county do you live in: (Please note: If you are outside CBR’s coverage area, you will need to apply with your area’s local Boxer rescue before adopting from CBR)(Required)

Email(Required)

Which are you applying for: Check all that apply(Required)

Adopt

Foster

Volunteer

Is there a specific boxer within CBR that you are interested in? If so, list name

Have you ever applied or been previously approved with CBR before?

Yes

Not Sure

Household information

How many adults, 18yrs and older, live in your household?(Required)

List the ages of all children under 18yrs old living in the home(Required)

Has everyone in your household agreed to adopt a dog?(Required)

Yes

Not Sure

Does anyone in the home have pet-related allergies?(Required)

Yes

Not Sure

Do you, or any members of your household, have any warrants for your arrest?(Required)

Yes

Not Sure

Have you or any household members ever been arrested, charged, or convicted of animal abuse, neglect or endangerment?(Required)

Yes

Not Sure

Please explain(Required)

House and Property

Do you currently rent or own your home?(Required)

Rent

Own

Other

If you rent, please provide landlord's name and phone number

Please specify your type of residence(Required)

House

Condo

Townhouse

Apartment

If you live in a condo, townhouse or development with a Homeowner’s Association, please provide the name and phone number of property manager or HOA officer

How long have you lived at this residence?

Do you have plans to move in the immediate future?

Yes

Do you have a pool?(Required)

Yes

What type of fence and how tall is the fence?

Do you have a fenced yard?(Required)

Yes

Is the pool enclosed?

Do you utilize doggie doors in your home?(Required)

Yes

Pet Information

How many dogs do you currently have living in your household?(Required)

Please list each dog’s breed, gender, age if they have been spayed or neutered. Or enter “N/A”- Not Applicable(Required)

If you currently have a dog(s), where do they stay during the day? Where will your new boxer spend their days?(Required)

If you currently have a dog(s), where do they stay at night? Where will your new boxer spend their nights?(Required)

If you have owned any dogs in the last 5yrs, other than those listed above, please explain what happened to them?(Required)

How many cats are currently living in your household?(Required)

Are the cats kept indoors, outdoors or both? Or enter “N/A” if you don’t have any cats(Required)

Vet's Information

Veterinarian or Animal Clinic Name(Required)

Veterinarian Phone Number(Required)

Is this your current vet?

Yes

If you do not have a vet, please explain?

Have your past and/or current dogs been given routine monthly heartworm prevention?(Required)

Yes

Additional Information

Have you ever owned a boxer?(Required)

Yes

Why have you chosen to adopt a boxer?(Required)

Do you prefer a Male or Female boxer?(Required)

Male

Female

No Preference

What age boxer do you prefer to adopt? Please list a range(Required)

How many hours on average will your dog be alone every day?(Required)

Are you willing to use a crate for your boxer?(Required)

Yes

Undecided

Who will care for your pet(s) when you're on vacation?(Required)

Are you willing to go through obedience training with your boxer?(Required)

Yes

How did you hear about Coastal Boxer Rescue (CBR)?(Required)

CONSENT: Please initial for each item below.

I am at least 21 yrs of age.

I understand that CBR's priority is to serve in the best interest of the Boxers under their care. Therefore, a pre-adoption home visit will be conducted by a CBR representative. CBR also reserves the right and sole discretion to refuse an adoption to anyone for any reason.(Required)

I am stating that I am financially and physically able to care for a boxer. I understand that proper food, required monthly heartworm prevention, and routine veterinary care can be costly, and I am able to meet these requirements.(Required)

I understand that if any information provided above is found to be false, it can render this application declined and I may not be considered for adopting or fostering through CBR.(Required)

I would like to receive the occasional communication/newsletter from Coastal Boxer Rescue of Florida, Inc via e-mail or mailings. CBR does not sell or share any personal data.(Required)

Yes

Please type your full name below to verify your online signature:(Required)

Hidden

Status

Hidden

Notes

Name

This field is for validation purposes and should be left unchanged.

Coastal Boxer Rescue utilizes the online donation services provided by PayPal. You do not need to have a paypal account in order to donate through paypal. You can choose to pay through your PayPal account or with your credit or debit card.

If you prefer to mail in your donation, checks can be mailed to:

Coastal Boxer Rescue of Florida
P.O. Box 121381
W. Melbourne Fl. 32912-1381.

* Please make checks payable to: Coastal Boxer Rescue of Florida Inc.