Name: 

Address: 

City, State, Zip: 

Home Phone Number: 

Cell Phone Number: 

Work Phone Number: 

E-mail Address: 

Website Address: 

Why do you want a Boxer? 

Do you have children? 
Yes No

If yes, what are their ages: 

Is anyone in the home allergic to dogs? 
Yes No

Do you agree to a background check? 
Yes No

Would you be willing to let us or an authorized agent do a home check?
Yes No

Have you or anyone in your household ever been convicted of a felony? 
Yes No

If yes, what was the charge and in what city/state were you charged?

Have you or anyone in your houseold ever been charged with animal cruelty? 
Yes No

If yes, in what city/state?

Are you allowed to own animals? 
Yes No

If no, please explain why not?

Do you have a fenced yard? 
Yes No

If yes, what is it constructed of, what is the height, and what type of locks are used on the gates?  If no fence, how do you plan to let your boxer exercise?

What is your GOAL for this dog? (check all that apply)
Well Behaved House Pet
Future Champion
Competitive Agility
Therapy/Assistance dog
Tracking 
Competitive Obedience

Do you prefer your Boxer to have Cropped or Natural ears? 
Cropped Natural

Have you ever shown a dog? 
Yes No

Have you or your handler ever put an AKC title on a dog? 
Yes No

If yes, please list who did it and name of dog(s) and title(s) obtained: 

Do you have a handler(s)? 
Yes No

If you do have a handler, please list name(s), phone number(s), & email addresses.

If you do not have a handler(s), would you be willing to hire one for the conformation ring? 
Yes No

Do you intend to use this dog for breeding? 
Yes No

Do you intend to do health testing before using this dog for breeding? 
Yes No

If yes, what tests do you plan to have performed?  If no, please explain your reason: 

Are you familiar with health problems associated with the breed?
Yes No

What sex of dog do you prefer?
Male Female No preference

What is your color preference? (check all that apply)
Brindle Reverse Brindle Fawn White (Limited Registration Only) Classic Flashy No preference

What age are you interested in?
Puppy Juvenile Adult No preference

How long are you willing to wait for a puppy (check all that apply)?
1-3 months 
3-6 months
6 months-1 year 
No preference

If we have nothing available would you like to be referred to a responsible breeder?
Yes No 

What type of residence do you live?
Single Family Dwelling 
Apartment
Townhouse/Condo
Other

Do you own or rent your place of residence?
Own Rent

If you rent are you allowed to have pets? 
Yes No

If you have a landlord please give name(s), phone number(s), and email addresses. 

Are you aware that Boxers are Large dogs (65-85 lbs.), and they do shed? 
Yes No

Will this Boxer be an indoor or outdoor pet?
Indoor Outdoor

Do you understand Boxers are not extreme weather dogs?
Yes No 

Where will this Boxer be kept while you are away from home? (ie: work, school, errands, vacation) Please explain in detail.

When you are away for extended periods of time what arrangements will/have been made to ensure the dog gets to eat, exercise, and use the bathroom?  Please explain in detail.

Where will this Boxer be kept while you are home? Please explain in detail.

Where will this Boxer be kept at night? Please explain in detail.

Do you understand the difference between Full and Limited Registration? (Companion pets will be sold on Limited Registration only!)
Yes No

Do you plan on attending training classes with your boxer?
Yes No

If yes, what kind of classes?  If no, please explain: 

Have you talked to other breeders?
Yes No

If yes, what breeders?: 

Do you agree to return your boxer to us if you can not keep it?
Yes No

Do you have an established vet we can contact as a reference?
Yes No

If yes, please list the name of vet(s), clinic(s), phone number(s) and address: 

Do you own or co-own any other animals?
Yes No

If yes, please tell us how many, what kind, and ages of all the animals you own or co-own.  Please list who they are co-owned with. 

Have you ever had to have a dog euthanized?
Yes No

If yes, please explain why: 

Please list 3 additional references: a friend, a neighbor, and either a handler, family member, or a breeder that are familiar with you and how you care for your animals.  Include: name(s), phone number(s), email address, and how long you have known each of them. 

Please list any additional information or comments: