Date:

Your full name:

Your email address: 

Your occupation:

Your daytime phone number (please include area code):

Your evening phone number (please include area code):

Address:
City:	State:Zip:

Spouse's name:

Spouse's occupation:

Reference (not a relative) who has known your animals and you as a pet owner (name and phone):


Relationship:

Years acquainted:

Do you live in:
  house in the country   single family house in town   condo
  townhouse   apartment    other

If other, please specify:


Do you rent or own your home?    rent   own

If renting, are pets allowed?     yes   no

If allowed, is there a weight limit?    yes   no

What is the weight limit?


If renting - landlord's name and phone number:


How long have you lived at this address?


If less than 2 years, previous address:


Do you have a fenced yard?     yes   no

Fence type:

Fence height:

What is the size of your fenced area?

If not fenced, how do you propose to
handle the dog's exercise and toilet duties?


Do you have a separate kennel run?    yes   no

If yes, what is the size of the kennel?


Do you have a Doggie Door?     yes   no

How many adults in the home?

How many children in the home?

The children's ages?


Are any members of your household home during the day? yes   no

Do you have other dogs?    yes   no

How many? Please give breed, sex and age.


Are they all spayed/neutered?   yes   no

If not, please tell which are not, and why.

Do you have any other animals/livestock?    yes   no

If yes, please list:


Who is your regular veterinarian? (name/phone)


Approximate date of last visit?

Were your animals current on vaccines?    yes   no

How many dogs have you owned in the last 5 years:


What happened to them? Please list by breed and disposition
(i.e., boxer/still have; boxer/died; dachshund/lost [stolen,
given away, etc.])


If any died - list age and cause


Have you owned boxers before?   yes   no

Why do you think you want to foster a boxer?



What sex do you prefer?
  no preference   male   female

Why?


Age preference:


Why?

Color preference?   No preference brindle   fawn   white

Are you willing to consider a boxer mix? yes   no

Where will the dog spend most of the day?
  Loose indoors   Crate   Basement   Garage   Fenced yard
  Loose outdoors   Tied up outdoors   Kennel run   Other

If other, please specify:


How many hours a day will the dog usually be alone?


Where will the dog spend most of each night?
  Loose indoors   Crate   Basement   Garage   Fenced yard
  Loose outdoors   Tied up outdoors   Kennel run   Other

If other, please specify:


When your family is away from home overnight
or on vacation, what will you do with the dog?


Do you agree to obey all leash laws?   yes   no

Would you agree to a housecheck, prior to fostering?    yes   no

Have you or anyone in your immediate family ever been convicted of a charge
of cruelty to animals, or are any such charges pending? yes   no

Why do you feel you would like to foster a dog at this time?



What is your manner of disciplining a dog?


How did you hear about Middle Tennessee Boxer Rescue?   Referred by Friend/Neighbor/Family Member Internet Search Engine Petfinder Referred by Other Rescue Group Veterinarian Newspaper Article Television Other 

If your answer was Friend/Neighbor/Family Member, please let us know who it was:
 (not required, but appreciated)

If your answer was "Search Engine," please tell us which one:

By submitting this form, I swear that all information contained herein is true and complete.