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Adoption Application

Adopt a Boerboel

First Name *

Last Name *

Email Address *

Date of Birth *

Month

Day

Year

Home Phone Number *

Cell Phone Number *

Work Phone Number *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

How Many Years at Current Address? *

Employer Name *

Employer Phone Number *

Employer Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Do you have a Spouse / Significant Other? *NoYes

First Name *

Last Name *

Spouse Home Phone Number *

Spouse Cell Phone Number *

Spouse Date of Birth *

Month

Day

Year

Spouse Email Address *

Spouse Employer Name *

Spouse Employer Phone Number *

Spouse Employer Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Do you own or rent your home? *OwnRent

Do you have Authorization from Your Land Lord to own large breed dog? *YesNo

Landlord First Name *

Landlord Last Name *

Landlord Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Landlord Phone Number *

How many children are in the home and what are their ages? *

Including yourself, how many people reside in your household? *

Does anyone in the household have pet allergies? *NoYes

Do you have a fenced yard? *NoYes

What type of fence? *

What is the height of the fence? *

Do any other pets reside in the home? *NoYes

What other pets reside in the home? Name, Breed, Age *

How many pets have you had in the last 10 years? If they are no longer with you please list breed and what happened to them..example death from old age, gave away..etc... *

Have you ever adopted a rescue before? *NoYes

Name and phone number of other rescues you have adopted from in the past. *

How many hours a day will your adopted dog spend alone? *

Where will your adopted dog be kept when you are not home? *

Where will your adopted dog sleep at night? *

We will require an inhome interview before adoption approval, is this something you are confortable with? *NoYes

Has any one in your home been investigated or convicted of animal abuse/neglect? *NoYes

Please explain.. *

Do you have a current Veterinarian? *NoYes

Name of current Veterinarian *

Vet Phone Number *

Who is listed as owner of your pets at your vets office? *

Are all of your pets spayed/neutered? *NoYes

Are all of your pets up to date on vaccines? *NoYes

Are all of your pets on a current heartworm/flea and tick prevenative? *NoYes

What Brand? *

Reference 1. (non-relative) First Name *

Reference 1. (non-relative) Last Name *

Reference 1. (non-relative) Phone *

Reference 2. (non-relative) First Name *

Reference 2. (non-relative) Last Name *

Reference 2. (non-relative) Phone *

Reference 3. (non-relative) First Name *

Reference 3. (non-relative) Last Name *

Reference 3. (non-relative) Phone *

Is there anything else you would like us to know?

Spouse E-Signature

Start signing your signature here

E-Signature *

Start signing your signature here

Consent *

I am looking to adopt a dog from Giant Paws Boerboel Rescue, Inc.. All the information I have provided to Giant Paws Boerboel Rescue, Inc. is true to the best of my knowledge.

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