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  Sample of an adoption contract 

Organization Name: KS/MO Boxer Rescue
Phone:(785) 841-7978 
Address_POB 8151 
City: Topeka State KS 66608
Web Site:


Your answers to these questions help us determine the best homes for our dogs, and the best dog for you. Incomplete applications will be discarded

Name:________________ Home Phone:(____)____-_____
Address:_______________________ Work Phone:(____)____-_____
Personal Reference:_____________________________ Years Aquainted:_______
Do you live in: _______House..._______Appt..._______Trailer..._______Other__________________ 
Do you: _______Own..._______Rent 
Previous Address________________________________
Do you have a fenced yard? _______Yes..._______No.......Kennel run:_______Yes..._______No 
If no, how will exercise/toilet be handled?_________________________ 
How many adults in house?_____ Children?___ ___Ages:________________ 
Do you own any other dogs? _______Yes..._______No.......Are they fixed? ___ __Yes..._____No 
Any other pets/livestock? _____Yes..._____No.....List:_____________________ 
Who is your veterinarian?___________________________________
If no regular vet, would you like a referral? _____Yes..._____No 
How many dogs have you owned in the last 5 years?_____________ 
What happened to your last dog?____________________________________
Have you owned a Boxer before? _____Yes..._____No 
Why do you want a Boxer?_________________________________________
What are your plans for this dog? 
_____Pet _____Guard _____Hunting _____Obed. _____S$R _____Other 
Are you willing to attend basic obedience training with the dog? _____ Yes _____ No

Do you want: _____Male _____Female _____Doesn't matter 
Do you want: _____Fawn _____Brindle _____White/Check _____Doesn't matter 
Do you want: _____Under 1 year _____1-5 years _____Over 5 years _____Doesn't matter 
Where will dog spend most of each day? 
_____Indoors _____Fenced yard _____crate _____Basement/Garage _____Teathered _____Kennel _____Other 
Where will dog sleep? 
_____Indoors _____Fenced yard _____crate _____Basement/Garage _____Kennel _____Other 
How many hours will dog be alone each day?_______________ 
Do you agree to the following: 
Spay/Neuter within 30 days? _____Yes _____No 
Keep current licence and ID tags on dog at all times? _____Yes _____No 
Provide timely health care for dog? _____Yes _____No 
Restrain dog in open vehicle? _____Yes _____No 
Return dog to Boxer Rescue if you can no longer keep or care for dog? _____Yes _____No 
Allow Boxer Rescue agent to visit your home prior to adoption? _____Yes _____No

Signature:__________________________ Date:___/____/____

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